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To the Editor: Dr Freedman and colleagues¹ detailed the clinical course of a 7-month-old infant with cutaneous anthrax. However, I find it disturbing that the working diagnosis, which remained preeminent until hospital day 12, was cutaneous and systemic loxoscelism (ie, recluse spider envenomation). Physicians and patients often ascribe otherwise unexplained skin lesions to Loxosceles reclusa or other spider envenomations with little if any supporting evidence.^2-5 Brown recluse spider bites essentially never occur outside this species' natural geographic range in the south central United States, where they are generally not regarded as a medical calamity,³ as typical of nonendemic regions. It is exceedingly unlikely that someone in the Manhattan area could be envenomated by a brown recluse spider. Without observing either the bite or a spider, the chance that this child (or anyone in a nonendemic area) had cutaneous or systemic loxoscelism was essentially nil, even if the clinical features appeared . . . [Full Text of this Article]

RELATED ARTICLE

Cutaneous Anthrax Associated With Microangiopathic Hemolytic Anemia and Coagulopathy in a 7-Month-Old Infant
Abigail Freedman, Olubunmi Afonja, Mary Wu Chang, Farzad Mostashari, Martin Blaser, Guillermo Perez-Perez, Herb Lazarus, Robert Schacht, Jane Guttenberg, Michael Traister, and William Borkowsky
JAMA. 2002;287(7):869-874.
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