Acute Myocarditis After Black Widow Spider Bite: A Case Report
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CASE REPORT
Acute Myocarditis After Black Widow Spider Bite: A Case Report A. Piscopo . F. Massari . P. Scicchitano
. M. Sanasi .
M. De Palo . P. Caldarola . M. Liccese . G. Calculli
Received: April 27, 2020 Ó The Author(s) 2020
ABSTRACT The black widow spider (BWS) is a venomous spider whose bite can cause various clinical conditions that range from local damage to serious systemic complications, including death. Cases of myocarditis following a BWS bite are rare but they can be fatal on occasion. However, the prognostic significance of the bite and presentation of myocarditis is unknown. Our case involved a 50-year-old man who presented with myocarditis after being bitten by a BWS and subsequently admitted to the intensive care unit for cardiac monitoring. During Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12292886. A. Piscopo F. Massari P. Scicchitano (&) M. Sanasi Cardiology Unit, Hospital ‘‘F. Perinei’’, Bari Local Health Authority (ASL Bari), Altamura, Bari, BA, Italy e-mail: [email protected]; [email protected] M. De Palo Cardiac Surgery Department, University of Bari, Bari, BA, Italy P. Caldarola Cardiology Unit, Hospital ‘‘San Paolo, Bari Local Health Authority (ASL Bari), Bari, BA, Italy M. Liccese G. Calculli Cardiology Unit, Hospital ‘‘Madonna Delle Grazie’’, Matera Local Health Authority (ASL Matera), Matera, MT, Italy
the hospital stay, he showed worsening signs on both the electrocardiographic and echocardiographic evaluations despite therapeutic success. Subsequent cardiac magnetic resonance and coronary angiography investigations showed no significant alterations; blood and instrumental test results slowly improved, and the patient was discharged home after 12 days of hospitalization without complications. This case illustrates that acute myocarditis, although an infrequent complication of BWS bite, has the potential to be lethal. The correct diagnosis, which is not always easy to formulate, is important to identify those patients who can benefit from careful monitoring and specific therapies aimed at reducing the risk of life.
Keywords: Black widow; Myocarditis; Spider
Heart
attack;
Cardiol Ther
CASE PRESENTATION Key Summary Points Envenomation from spiders can cause serious adverse events. We observed a case of myocarditis in a person bitten by a black widow spider. Rapid admission to the ward and the empirical treatments were fundamental to therapeutic success. Myocarditis from spider bites should be considered as possible adverse effects although they are rare events.
INTRODUCTION Latrodectus tredecimguttatus, more commonly known as the Mediterranean black widow spider, is a 12- to 15-mm-large spider with several red, hourglass-shaped marks on its abdomen [1, 2]. Its bite releases a neurotoxic alpha-latrotoxin that binds to the pre-synaptic neuronal receptor neurexin, inserts itself into the neuronal membrane, and creates a transmembrane calcium channel that mediates exocytosis of noradrenaline/acetylcholine and
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