Dermonecrotic Loxoscelism in the Mediterranean region

Publications on loxosceles spider bites in the Mediterranean region are scarce. This spider is frequently found in Israel and its bite may cause severe medical problem. We report on 11 patients who sustained such bites and required hospitalization between 1988 and 1997 in a regional hospital serving a population of 300,000. Most of them were bitten in the summer, 10 on the medial aspect of the arm or thigh. All patients exhibited the typical loxosceles skin lesion; systemic manifestations were evident in six. Seven patients were misdiagnosed. All were treated with antibiotics and eight with the addition of corticosteroids. Ten patients fully recovered within 2-3 weeks. The estimated incidence of severe dermonecrotic loxoscelism requiring hospitalization is 0.37 cases/100,000 population/year. It seems that the clinical course in our cases was somewhat milder than in other reported cases from the United States. This can possibly be attributed to the bite of Loxosceles rufescens, which is the prevailing species in this region. In conclusion, this clinical entity is common and frequently misdiagnosed. Appropriate diagnosis requires awareness of and alertness to loxosceles bite.