Toslcon, 1969, Vol . 6, pp. 299-300. Perasmoa Pros . Printed in Grost Bntun

SHORT COMMUNICATIONS

POSSIBLE PERIPHERAL NEURITIS FOLLOWING A BLACKWIDOW SPIDER BITE

WARREN JACOBS815 E . Pennsylvania Avenue, Escondido, California, U.S.A .

(Acceptedjor publics/ion 10 Norernber 1968)

ON 10 April 1968 a 13-year-old white male felt something `wet' on his left forearm whileputting on his jacket during a camping trip near Borrego Springs, California . From thecuff of his jacket he pulled out what he first thought was a piece of black string, but whichon further examination was described as a crumpled, soft, black mass about 2 cm across .There was no immediate concern as the patient did not know what the mass was, nor werethere any complaints ; but approximately 20 min later the patient complained of backache,some muscular weakness, numbness and tingling in the hands and feet, and pains in thejoints and large muscle masses . On examining his left forearm he noted a very small `bitehole .'

The following day a red ring and slight edema appeared around the injured area . Thepatient still complained of weakness and mild tremor of the limbs, and experienced somedif%culty in walking . The muscular weakness increased so that by several days followingthe bite he walked with a marked waddling gait, and had extreme difficulty in maintainingmuscular tone after prolonged walking or standing . He could move about only withthe aid of crutches . There was tenderness in the muscles of the gluteal regions, thighs andcalves . The muscular deficits were limited to the lower extremities.

The patient was seen on 6 June, 1968 by Doctors F. E. Russell and H. S. Barrows atthe Los Angeles County-University ofSouthern California Medical Center . The diagnosisof black widow spider venom poisoning was confirmed . Neurological examination revealedmarked weakness of the pelvic muscles, particularly the glutei and abductors of the thighs .This weakness caused a marked waddling gait . There was some weakness of the dorsi-flexors of both feet . There was no atrophy . Reflexes and sensation were intact except foran area of diminished sensation over the medial aspects of the left calf. There was somesciatic tenderness on deep palpation bilaterally in the sciatic notch. An electromyogramwas performed and was reported normal . CPK was 25 units (normal 0-35 units) and bloodaldolase 6~2 units (normal less than 12). There was a history of muscular dystrophy in acousin .

The differential diagnosis included muscular dystrophy, a subacute form of polymyositislimited to the pelvic muscles, and polyneuritis and polymyositis associated with blackwidow spider poisoning. Dr. Russell (personal communication) has observed peripheralneuritis of approximately 6 months' duration in a child stung by a bee. He has also seen a

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limited peripheral neuritis and myositis in a patient bitten by an elapid snake, and a similarepisode ofneuritis following snakebite has been reported, SEAL [1 ] .

The consensus of opinion appeared to favor a diagnosis of polymyositis of unknownetiology or muscular dystrophy with the stress reaction being the black widow spider bite.The patient returned to his home and continued to experience pain in addition to his weak-ness for approximately 8 weeks. Then both pain and muscular weakness began to recedeand when seen on 9 September 1968, all motor and sensory deficits had disappeared andthe child was perfectly well .

It would appear that the peripheral polyneuritis and polymyositis were, if not due to theblack widow spider poisoning, manifestations of a disease precipitated by it . This unusualcase is reported in the event that similar experiences might have occurred and goneunnoticed.Acknowledgements-The author wishes to acknowledge the consultation and advice of Professor F. E.RUSSELL. He is also indebted to Doctors H. S. Bwttttow, R. A. Pencocx andW. Ds BOLT for consultations.

REFERENCE[l ]

SEAL, S. C., Snake bite and neuritis . Calcutta nred. J. 26, 185, 1931 .