By the time John Dean of Drexel, Mo., arrived at Truman Medical Center, the black spot of dead flesh on the back of his thigh had grown to the size of a fist, and the redness and swelling around it radiated pain up and down his leg.
“Necrotizing fasciitis started being thrown around as a possible diagnosis, and (with) the alarm that was causing, I was admitted to the surgical unit,” Dean said.
Necrotizing fasciitis is a “flesh-eating” infection that is fatal about 20 percent of the time and often requires daily trips to the operating room to carve out infected material.
With doctors considering that regimen for Dean, Adam Algren, the hospital’s chief toxicologist, put the brakes on the whole thing. Dean didn’t have necrotizing fasciitis, Algren said. He had been bitten by a brown recluse spider.
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Weeks later, Dean is recovering and the wound is healing and may not need any surgery. His case is a reminder that brown recluse bites, while rare, do happen in this region, and they can be hard for both patients and medical providers to identify.
Brown recluse spiders live all over Kansas and Missouri, and they’re most active from March to October. Bites are rare because the spider avoids humans. Bites that cause damage like what Dean suffered are even rarer.
Dean said he didn’t feel the initial bite, which is not unusual. But as the venom spread and his leg swelled, he couldn’t help but feel it.
“I woke up in the middle of the night, 2 a.m.,” Dean said. “Had an intense fever, and the back of my leg was on fire.”
He tried ice and ibuprofen. The next day, his primary care doctor put him on antibiotics and told him to go to the emergency room if the infection continued to spread. It did, and within days the wound started to turn black as the skin died.
The first hospital Dean went to told him he’d have to wait for a surgical consult, so he went to Truman, where his daughter is an emergency room physician.
That put him in the orbit of Algren, a national expert on brown recluse bites. Algren said he sees about 20 to 30 hospitalizations a year at Children’s Mercy Hospital, because kids are more sensitive to the venom. He sees only one or two adults a year, and few have damage like Dean’s.
“For size of wound, his was probably one of the largest I’ve seen,” Algren said.
The key to determining that Dean didn’t have necrotizing fasciitis was that he was otherwise in pretty good health. He had a fever and an odd rash on his back, but he was coherent and not in agony.
It was an important distinction, because the protocol for treating a brown recluse bite is the opposite of the protocol for necrotizing fasciitis in terms of surgery.
“If you’re pretty convinced it’s a brown recluse bite, you want to leave it alone, at least for a couple months,” Algren said.
The damage to Dean’s leg penetrated through all the layers of skin and subcutaneous fat, but stopped at the membrane that encases his thigh muscle. He’s being evaluated by Truman surgeon Douglas Geehan for potential debridement surgery and skin grafting, but Geehan and Dean are both hoping the wound will scar over on its own.
Although Dean’s case didn’t turn out to be as dire as initially feared, Geehan said it was still good that he got to the hospital. If left untreated, brown recluse bites can lead to more serious secondary infections.
“The thing I think would be important is to not brush off things as just a spider bite,” Geehan said. “That if we do see surrounding evidence of cellulitis or redness, it may be something else, and so that’s a significant part of why it’s important to seek medical attention if you have one of these.”
Geehan and Algren both said it’s a good idea to shake out shoes and keep clothes off the floor, because that’s where brown recluses tend to hide before they end up in contact with people.
Dean said he’s not sure exactly where he met his spider. There’s a barn on his property where he stores his lawnmower and a wood pile he recently cleared that are good bets. Regardless, he’s just glad he’s on the mend.
“A spider bite took a big chunk out of my leg, and so far it’s taken two weeks out of my life,” Dean said. “A spider bite. Never thought that would happen.”