Spider Bite-Induced Facial Nerve Palsy

Abstract

Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the suspected presence of appropriate vectors. While most arthropod bites will only result in mild localized irritation, the potential to cause severe cutaneous and systemic effects should not be overlooked. We present one such case, in which a presumed brown recluse (Loxosceles reclusa) bite on the neck resulted in severe illness with systemic manifestations. The patient presented to the emergency room minimally responsive with left-sided facial nerve palsy and septic shock. While the admitting physician initially prioritized stabilizing the patient, he noted the left-sided cervical cellulitis. Thorough history taking revealed that the patient had been worsening since being bitten by a spider three days prior to admission. After a month-long hospital stay and multidisciplinary treatment, the patient was transferred to a larger center with facial paralysis still present.

Keywords: bell's palsy; brown recluse; facial nerve palsy; facial nerve paralysis; loxoscelism; septic shock.

Figure 1. Lung CT, transverse cut, with cavitation suggestive of septic pulmonary emboli.

CT: computed tomography

Figure 2. Apical lung CT, transverse cut, with cavitation suggestive of septic pulmonary emboli.

CT: computed tomography

Figure 3. Neck CT, transverse cut, showing cellulitis (rotated 90 degrees clockwise).

CT: computed tomography