My 11 year old son woke up Sunday morning, July 17, 2005, with an all-over-body rash. The rash was lacey in appearance, similar to what someone might experience when having an allergic reaction. I immediately noticed a swollen place on his shoulder that was about the size of a half-dollar. It did not occur to me for several hours that it might be a spider bite. Eventually, I pulled back the covers and found the remnants of what could be a brown recluse or another spider. He had apparently been bitten in his sleep and rolled over on the creature squishing it and breaking it into pieces. (Lovely image, I know.) By mid afternoon, he had a 102 temp, the lacey rash had become a solid redness all over his body, he was swollen all over especially obvious in the face and hands, and he had a headache. At that point I decided to take him to the ER. (I failed to mention to you that we were 550 miles away from our home town, visiting my grandparents, who live in a rural area of north Louisiana.)
The bite wound had developed a pimple looking place in the center of the swollen area. The doctor at the ER didn’t even look at the bite, he looked at the rash and said that it was a scarlatina rash which often accompanies strep. He did a throat culture and ordered a blood test and then his shift was over. The next doctor came in with the test results and said that it was not strep, but still did not act like he believed it was a spider bite. The white blood cell count was at 14000 (normal is 2000 – 12000). Since that can indicate an infection, they sent us home with a prescription for Keflex (an antibiotic).
Monday morning, we found a LIVE brown recluse spider which confirmed in my mind that he had a BR bite. The insect parts that we found in the bed on Sunday matched the BR that we found on Monday. I took him to a walk-in clinic on Monday because the swelling was worse and the rash, headache and a low-grade fever was still present. The doctor put him on Augmentin (an antibiotic) and Clarinex (an antihistamine), but still did not acknowledge that the wound was from a BR bite. I even took the spider that we found with us and he confirmed that it was a BR. He said he had never heard of a scarlatina rash accompanying a BR bite and told me that the rash was characteristic of STREP. He said the Augmentin that he prescribed would help Strep or a Spider Bite, so that it really didn’t matter which diagnosis was accurate. He did say that if a petechial rash appeared to let him know – he had treated a spider bite victim that developed petechiae. (Petechiae are little red blood spots under the skin – often referred to as pin-point bruising.) I left discouraged. My motherly instincts were telling me that my “never-gets-sick” son had not woken up with a wound on his arm and coincidentally developed strep throat at the same time.
Low and behold, the next day (Tuesday) he woke up with petechiae all over his back. I went back to the walk-in clinic to see the same doctor and he was off-duty! UGH! They were backed up so they sent me back to the ER – UGH, again! The doctor on duty this time said it looked like a staff infection and wanted to change the antibiotics. He ordered more blood work to see if it indicted anything. It came back completely normal – WBC count was back to normal. Blood coagulation test was normal. He decided to order a urinalysis – not sure why – it came back with bacteria in it, but no pus cells, which is odd. Pus cells usually accompany a UTI, but he decided that it was a UTI anyways. My son was also complaining of an intense feeling of “hot needles” poking into his back, his head and his upper lip. This sensation would come and go – especially when he walked outside into the sunlight and heat. To that, the doctor said, “you are a weird kid!” He prescribed Bactrim instead of the Augmentin, told us to apply HOT compresses to help kill the STAFF infection, and he prescribed Dapsone, which he said had occasionally been used to treat spider bites and he would prescribe it “if it will make you feel better”. I felt so patronized – I was so confused as to what to give him.
I called my pediatrician who said the Augmentin was fine and that he did not have enough proof that Dapsone did any good and therefore, would not recommend it. He also said that everyone reacts differently to spider bites – especially children. You are never to put hot compresses on a spider bite because that makes the venom spread – good thing I didn’t follow the ER doctor’s instructions. Just because the wound was not festered up like some BR bites, didn’t mean that it was not a BR bite and just because all of these other symptoms were accompanying it, didn’t exclude it from being a BR bite. He suggested that the various reactions were just my son’s body fighting off the venom.
On Wednesday, my son was doing a lot better and we headed home. The all-over redness was mostly gone and the spider bite was less hot, less swollen and less red. He still had the occasional hot tingling sensation, but it wasn’t as severe. He was still breaking out in petechiae, but I decided we would be better off to go home and see a doctor I could trust.
On Thursday, we went to our regular pediatrician who immediately diagnosed the wound as a brown recluse spider bite. He looked over the test results from the hospital and said that there was no indication of a UTI, strep or staff infection and that he really thinks the symptoms are from the envenomation. The body does weird things when it is attacking a foreign substance, such as venom. He attributes the antibiotic therapy to preventing the wound from getting worse. He feels we are on the road to recovery!