Violent abdominal pain drives a 50-year-old into the emergency room. The man lives in Ontario, in the southernmost tip of Canada. The complaints had suddenly started in the morning, he says. The pain is convulsive and diffuse, he can not fix it at a certain point.
Around the same time as the abdominal cramps, another problem began. The man constantly feels that he needs to go to the bathroom urgently, but then hardly anything dripped into the bowl. But the 50-year-old sweats heavily, the doctors report to Matthew Carere of the University of Ottawa in the "Canadian Journal of Emergency Medicine".
In a first examination, the doctors find traces of blood in the urine, in addition, the lactate value is slightly increased. Although the 50-year-old reported an insect or spider bite on the lecture - the doctors consider it irrelevant. Instead, they type in a kidney colic. Everything seems to fit.
Renal colic is usually caused by urinary calculi stuck in the urethra. As the muscles try to push the urinary stones towards the bladder, cramping pain occurs. Sweats are also among the typical complaints. In addition, the stones prevent the urine from draining properly and sometimes there is blood in the urine.
The doctors give the 50-year-old a painkiller and organize an outpatient appointment with a radiologist. Then they send him home.
Back there!
In the late afternoon, however, the patient is back in the ER, his pain is now too extreme. In a new blood test, the doctors come up again on increased lactate levels. They transfer their patients to a clinical treatment center to take direct X-rays.
On arrival, the man visibly feels bad, he sweats excessively, his eyelids are swollen on both sides. As the doctors palpate his stomach, his muscles tighten automatically. Such a defense tension speaks for an inflammation in the abdominal cavity, the body tries to protect the area.
The man's heart and breathing are functioning normally, also blood tests, analyzes of the urine and liver function tests provide no further indications. Only his body temperature is slightly elevated. In addition, the 50-year-old has an extremely high blood pressure (210/128).
In conversation with the doctors, the man again points out his experience from the previous day. When walking through tall grass he suddenly had the feeling that an insect or a spider had bitten him. What was initially only a minor annoyance developed into excruciating pain in the area of the bite within two hours. The man could still sleep, but the abdominal discomfort followed in the morning.
The doctors can detect neither traces of a bite nor a rash. But the man's complaints are getting worse. The 50-year-olds overcome again and again strong pain, which now pull down the legs and bundle in the soles of the feet.
The black attacker
When the doctors hold the CT images in their hands, they only see a massively stretched bladder. The man has no kidney stones. For that, one liter of urine flows off as they put a catheter on the man. Because your patient does not seem to be suffering from infection, inflammation, or other organic causes, doctors are considering poisoning-possibly by the insect or a spider? They ask a toxicologist for help who actually solves the puzzle.
The sweat of the 50-year-old, the high blood pressure, the pain and the other complaints fit perfectly to the poison of a rare, but very dreaded inhabitant of his homeland: the Black Widow. The spiders are found in Canada only in the warmest regions near the US border, but could be spread by climate change, write the doctors.
imago / ZUMA Press
Black Widow (Latrodectus Hesperus)
Their notorious reputation owes the Black Widows especially their reproduction. After mating, the much larger females, according to legend, kill the much smaller, harmless males. In reality, however, that rarely happens.
Even in humans, an encounter with the Black Widow ends extremely rarely deadly, but sometimes very painful. Their venom causes the nerves release large amounts of messengers, the consequences include high blood pressure and severe muscle pain.
Most sufferers recover by themselves within 72 hours. In particularly severe cases, doctors can also use the antiviral antidote. However, this carries the risk of severe side effects such as allergic reactions, the authors write.
Black Widow - also appeared in Germany
In the 50-year-old doctors refrain from antivenin, instead they give him infusions for his fluid balance and opioids for the pain. He also receives a drug that lowers his blood pressure. On the second day after arriving at the emergency room, the pain has improved significantly. The man can also urinate again.
To make sure that they have really overlooked nothing, the doctors once again clarify all possible causes of the symptoms: A malignant enlargement of the prostate? A pathologically altered thyroid? A toxicological syndrome? None of this is true, the bite remains the diagnosis. Two days after his arrival, the man can leave the hospital.
There are about 30 Black Widow species worldwide, and one is also found in Europe - especially in regions around the Mediterranean. In Germany, the animals have so far been introduced only occasionally in fruit deliveries.