P-ANCA vasculitis with diffuse alveolar haemorrhage preceded by a spider bite

• Published in: BMJ case reports Vol. 13; no. 6; p. e233710
• Main Authors: Ali, Ali Hameed, Kang, Mandip Singh, Aldahwi, Jaafar, Reyes, Candice
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17.06.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Abdomen; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - etiology; Antibodies; Anticoagulants; Antigens; Bacterial infections; Biopsy; Case reports; Hemorrhage - etiology; Hospitals; Humans; Hypotheses; Immunotherapy; Insect bites; Lung Diseases - etiology; Male; Monoclonal antibodies; Neutrophils; Pathogenesis; Peptides; Pulmonary Alveoli - pathology; Pulmonary embolisms; Respiratory failure; Skin; Skin diseases; Spider Bites - complications; Spiders; Staphylococcus infections; Streptococcus infections; Unusual Association of Diseases/Symptoms; Venom; vasculitis; dermatological
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-233710

We report a patient with antineutrophilic cytoplasmic antibody (ANCA) vasculitis that was preceded by witnessed black widow spider bites. The patient initially presented with a diffuse painful skin rash that developed after a few hours post bite. He was treated initially with topical ointment for the suspected bite. However, subsequently a few days later the patient returned to the hospital with similar, but more progressive rash with haemoptysis and acute hypoxic respiratory failure requiring supplemental oxygen. Immunology work up showed elevated titre of peri-nuclear ANCA. Bronchoscopy revealed diffuse alveolar haemorrhage. The patient was treated successfully with methylprednisolone and rituximab.