3. While moving boxes in a garage, a patient feels a pinprick on the forearm. Within an hour, the patient develops severe generalized muscle cramping, diaphoresis, hypertension, tachycardia, nausea, and a rigid, painful abdomen. The bite site has only mild swelling and two tiny puncture marks. Which exposure best fits this presentation?
✓ Correct Answer: B. Black widow spider envenomation
Why this is correct
Black widow venom is neurotoxic and can produce severe regional or generalized muscle spasm, abdominal-wall rigidity, diaphoresis, autonomic instability, nausea, and vomiting despite modest local findings. Analgesia, control of muscle spasm, monitoring, poison-center consultation, and selective consideration of antivenom are based on severity.
Why the other answers are incorrect
A. Brown recluse spider envenomation
Brown recluse bites more often evolve toward local ischemia, blistering, a violaceous lesion, and delayed necrosis. The dramatic muscle spasm and autonomic syndrome point away from loxoscelism.
C. Pit-viper envenomation
Pit-viper bites usually cause progressive local pain and swelling with possible coagulopathy and systemic toxicity rather than a small local lesion with intense generalized muscle cramping.
D. Scombroid fish poisoning
Scombroid poisoning follows ingestion of improperly stored fish and typically causes flushing, headache, palpitations, urticaria-like symptoms, and gastrointestinal upset. It does not cause fang marks or this neurotoxic spasm pattern.
🧠 Make It Stick
Black widow = neurotoxic and tight; brown recluse = tissue-toxic and necrotic.
💉 Clinical Connection
A rigid abdomen after a black-widow bite can mimic an acute surgical abdomen. Exposure history and the combination of muscle spasm, diaphoresis, and autonomic findings are key clues.
📚 Sources
Emergency Nurses Association. Emergency Nursing Core Curriculum, 8th ed. Chapter 12, Environmental Emergencies, Spider Envenomation, pp. 179–181.
Emergency Nurses Association. Sheehy's Manual of Emergency Care, 8th ed. Chapter 31, Bite and Sting Emergencies, Spider (Arachnid) Bites, p. 369.