Case #9

HISTORY

The patient is a 31 year old semi-truck driver who presents to the ED with a complaint of severe abdominal pain and cramping of 6 hours duration associated with diaphoresis, low grade fever and anorexia.

The patient is normally healthy, no previous abdominal history, no kidney stones. Past history significant for an alligator bite to the leg 5 years ago. Smokes unfiltered Camel cigarettes, drinks whiskey "When I'm not haulin' a load" No recreational drug abuse.

PHYSICAL

• General: Severe pain distress, rocking side to side in fetal position
• Vitals: P=120 RR=40 T=100.4 BP=150/90
• HEENT: PERRL 4mm Neck: Supple
• Lungs: CTA Ht: RRR S1S2
• GI: Severe diffuse abdominal tenderness with rebound and guarding Rectal: (-)Heme
• Ext: Diaphoretic, good pulses, nl color
• Neuro: No focal defs

DIAGNOSTIC STUDIES

• CBC: WBC=19.4 H/H=45/15 PLT=313K
• Lytes: Na=140 K=4.0 Cl=110 HCO3=23
• BUN/Cr: 15/0.9
• Amylase: 92 LFTs: WNL
• KUB/CXR: Nonspecific bowel gas pattern, no free air
• U/A: (-)WBCs (-)RBCs

CLINICAL COURSE

While hauling cable wire from the "4 corners" region of the Southwest US, the patient he recalls feeling "a pin prick" on his ankle. After which, he spotted a spider with a "red spot on its belly" crawling across the truck floor mat. He developed severe pain in his abdomen as he started to enter the Midwest, and pulled off the road upon entering the Chicago city limits.

Click here to  see the spider.

Toxin and Discussion References