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July 3, 2002

Diagnosis and Treatment of Cutaneous Anthrax

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(1):43-44. doi:10.1001/jama.288.1.42

To the Editor: Dr Freedman and colleagues1 detailed the clinical course of a 7-month-old infant with cutaneous anthrax. However, I find it disturbing that the working diagnosis, which remained preeminent until hospital day 12, was cutaneous and systemic loxoscelism (ie, recluse spider envenomation). Physicians and patients often ascribe otherwise unexplained skin lesions to Loxosceles reclusa or other spider envenomations with little if any supporting evidence.2-5 Brown recluse spider bites essentially never occur outside this species' natural geographic range in the south central United States, where they are generally not regarded as a medical calamity,3 as typical of nonendemic regions. It is exceedingly unlikely that someone in the Manhattan area could be envenomated by a brown recluse spider. Without observing either the bite or a spider, the chance that this child (or anyone in a nonendemic area) had cutaneous or systemic loxoscelism was essentially nil, even if the clinical features appeared consistent. Furthermore, assigning the diagnosis of loxoscelism served no useful purpose, because supportive care alone is the mainstay of treatment for brown recluse spider envenomation.