This healthy 69 year old man was bitten by a brown recluse spider while spring cleaning in the basement of his house. He initially noted stinging and itching at the site. Nine hours later he was evaluated in the emergency room for redness of the ears, perioral pallor, and light headedness. He was given oral and intramuscular corticosteroids and instructed to follow up with his primary care doctor. On the second day after the bite his oral steroid were increased when purpura was noted at the site. On day 3 he developed a blister that progressed quickly to a necrotic ulcer. Over the subsequent 7 weeks the wound was cleaned and debrided by his family doctor, and 2 months after the bite the ulcer was grafted with skin taken from the right hip. Although the graft took well and the wound healed quickly, he still experiences occasional burning and stinging at the site.
