RHABDOMYOLYSIS IN PRESUMED VISCERO-CUTANEOUS LOXOSCELISM: REPORT OF TWO CASES

França, F.O.S.(1,2), Barbaro, K.C.(3), Abdulkader, R.C.R.M.(4)

(1)Hospital Vital Brazil, Instituto Butantan, (2)Clínica de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, (3)Laboratório de Imunopatologia, Instituto Butantan, (4)Laboratório de Fisiopatologia Renal, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Loxoscelism is an important form of spider envenomation in Brazil. From 1990 to 1993 Loxosceles spiders were the responsible agent for 36.6% out of 17.785 arachnid accidents reported in Brazil. In humans, Loxosceles spider bites usually cause a relatively painless dermonecrotic lesion (87 to 99% of the cases) characterized by erythema, swelling and tenderness which evolves to necrosis, ulcer and scar. In viscero-cutaneous loxoscelism (1 to 13% of the cases), besides the typical cutaneous lesion, there is systemic involvement with intravascular hemolysis, thrombocytopenia, disseminated intravascular coagulation and acute renal failure. Until now, discoloured urine in viscero-cutaneous loxoscelism has been attributed only to haemoglobinuria induced by the intravascular hemolysis caused by the venom. Here two cases (in Brazil) of viscero-cutaneous loxoscelism with rhabdomyolysis and acute renal failure are described. Both patients presented severe oedema, erythema and dermonecrosis at the bite site. Elevated creatinekinase levels were found in both cases (6,841 and 1,718 U/L) associated with severe acute renal failure (one required dialysis for 50 days). The observed rhabdomyolysis was probably induced by the intense inflammatory process caused by the venom that may have spread down into the muscular layers. Therefore, in viscero-cutaneous loxoscelism, rhabdomyolysis secondary to intense local tissue damage can occur and should be considered as a contributing factor in acute renal failure. Creatinekinase should be monitored in viscero-cutaneous loxoscelism to avoid acute renal failure and to reduce the severity of any renal damage.

CORRESPONDENCE TO:

FRANÇA, F.O.S., Hospital Vital Brazil, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo, 05503-900, SP, Brasil, Email: fosfranca@uol.com.br