Abstract
Latrodectus geometricus, also known as the brown widow spider, is one of 5 United States species from the widow family. Its venom, characterized as a neurotoxin, produces symptoms including widespread muscle spasm. The toxin has been known to mimic severe abdominal disorders such as acute appendicitis and ruptured ovarian cysts. We report a single case involving a previously healthy adult male who presented to the emergency department with neuropathy and foot drop after confirmed envenomation with the neurotoxin from a brown widow spider (Latrodectus geometricus). His injury occurred approximately 2 weeks prior to presentation. MRI of the lumbar spine revealed an enhanced paraspinal muscular lesion at T2 extending into the gluteal muscles. Cerebrospinal fluid analysis was normal. EMG and nerve conduction studies were compatible with peripheral neuropathy, active denervation of the right gastrocnemius muscle, and signs consistent with active demyelination. Neurologic manifestation of typical radiculopathy was clouded by paraspinal muscular inflammation related to rhabdomyolysis. He was eventually diagnosed with mononeuritis, right foot drop, moderate rhabdomyolysis, and severe neuropathic pain. His severe neurological devastation was attributed to envenomation with the brown widow spider neurotoxin. His symptoms persisted for more than 7 months after initial exposure and led to significant alterations in the patient's quality of life. A plethora of information exists explaining the short-term complications of widow spider envenomation. Very little literature exists concerning long-term neurological complications of widow toxin exposure, particularly brown widow spider envenomation. Awareness of the possibility of devastating complications is beneficial and will aid in future development and institution of early preventive management.