{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:40:08Z","timestamp":1756359608098,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,11]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>A male infant presented with swelling of the left leg and fever. Over the next 2\u2009days, the area developed fasciitis extending to the left thigh, abdomen, and lower chest. Meanwhile, the parents found a giant brown spider within the infant\u2019s cot belonging to the genus <jats:italic>Loxosceles<\/jats:italic>, otherwise called the brown recluse spider. The dermo-myonecrosis progressed to deeper tissues involving the lung parenchyma requiring invasive ventilation. CT of the thorax showed multiple pneumatoceles, and lung biopsy showed alveolar necrosis. The infant was treated with intravenous antibiotics and corticosteroids. We drained the pneumothoraces by thoracostomy and insertion of intercostal drainage tubes. The infant required respiratory support initially by conventional ventilation, which was escalated to high-frequency oscillatory ventilation. He had refractory hypoxaemia and died. This is the first fatal case of acute spider envenomation described in India. Spider envenomation must be considered in patients with sudden onset, rapidly progressive necrotising fasciitis unresponsive to antibiotic therapy.<\/jats:p>","DOI":"10.1136\/bcr-2022-253018","type":"journal-article","created":{"date-parts":[[2022,11,24]],"date-time":"2022-11-24T12:52:37Z","timestamp":1669294357000},"page":"e253018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Acute necrotic arachnidism with necrotising fasciitis and recurrent pneumothorax"],"prefix":"10.1136","volume":"15","author":[{"given":"Jasleen","family":"Duggal","sequence":"first","affiliation":[{"name":"Paediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swathi Sunil","family":"Rao","sequence":"additional","affiliation":[{"name":"Pediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5266-8334","authenticated-orcid":false,"given":"Shiva Kumar","family":"Reddy","sequence":"additional","affiliation":[{"name":"Paediatrics, Nitte(Deemed to be University), KS Hegde Medical Academy, Mangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,24]]},"reference":[{"key":"2025082722253688000_15.11.e253018.1","first-page":"869","article-title":"Common spider bites","volume":"75","author":"Diaz","year":"2007","journal-title":"Am Fam Physician"},{"key":"2025082722253688000_15.11.e253018.2","first-page":"54","article-title":"Poisonous spiders: bites, symptoms, and treatment; an educational review","volume":"2","author":"Rahmani","year":"2014","journal-title":"Emerg"},{"key":"2025082722253688000_15.11.e253018.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62230-1"},{"key":"2025082722253688000_15.11.e253018.4","unstructured":"Paul R , Santra S , Banerjee AK . 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