Coexistence of Rhabdomyolysis, Myocarditis and Arrhythmia after Spider Bite: A Case Report

• Published in: Journal of tropical pediatrics (1980) Vol. 68; no. 3
• Main Authors: Yılmaz, Münevver, Akçay, Gürbüz, Gürses, Dolunay
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 05-04-2022
• Subjects: Animals; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Black Widow Spider; Female; Humans; Myocarditis - diagnosis; Myocarditis - etiology; Rhabdomyolysis; Spider Bites - chemically induced; Spider Bites - complications; Spider Bites - diagnosis; Spider Venoms - adverse effects; spider bite; case report; rhabdomyolysis; myocarditis; arrhythmia; black widow
• DOI: 10.1093/tropej/fmac027
• EISSN: 1465-3664
• ISSN: 0142-6338

ABSTRACT
Background
Rhabdomyolysis after spider bite has been reported in a small number of patients, and myocarditis in even fewer. However, arrhythmia associated with latrodectism in children has not been described in the literature to date.
Case summary
A girl presented approximately 4.5 h after being bitten on the left ankle by a black spider. Two unifocal premature ventricular contractions (PVCs) were observed on the electrocardiogram. In laboratory tests, creatine kinase was elevated. On day 2, levels of troponin, pro-brain and natriuretic peptide were elevated. Electrocardiogram revealed inverted and biphasic T waves. Echocardiography revealed mild left ventricular dilation, mitral and aortic valve regurgitation. Holter electrocardiogram showed PVCs. Her laboratory and echocardiography findings completely normalized after discharge, and no arrhythmia was observed on the Holter electrocardiogram during outpatient follow-up.
Conclusion
Although spider bites are uncommon, they can cause serious systemic effects. These patients should be evaluated for arrhythmia, rhabdomyolysis and myocarditis.
Lay Summary
Rarely, spider bites can cause serious systemic effects, severe morbidity and death. In a small number of patients, spider envenomation causes rhabdomyolysis and myocarditis. In the present case, the elevated troponin and pro-brain natriuretic peptide levels and electrocardiogram/echocardiography findings were consistent with myocarditis, and an increase in creatinine kinase level indicated rhabdomyolysis. In addition, the electrocardiogram and Holter electrocardiogram revealed unifocal premature ventricular contraction. To our knowledge, arrhythmia due to Latrodectus spider bite has not been described in children to date. In addition, this case demonstrates the coexistence of two serious systemic effects, rhabdomyolysis and myocarditis, with full recovery after appropriate treatment.