Suspected Cutaneous Loxoscelism Presenting with Necrotic Foot Lesions in Zagreb, Croatia: A Case Report and Literature Review

Background: Loxoscelism, the clinical syndrome caused by envenomation by recluse spiders of the genus Loxosceles, is one of only two spider-bite syndromes of medical importance in Croatia. In Europe, the Mediterranean recluse spider (Loxosceles rufescens) is the sole representative of the genus, and its presence has been documented in Croatia, where it is the only venomous spider of medical importance besides Latrodectus spp. Case Presentation: A previously healthy 46-year-old Caucasian woman presented to the emergency department of the University Hospital Centre Zagreb after being bitten on the right foot by an unidentified arthropod while at work in a supermarket. She initially developed a small, painful, pruritic papule that progressed to a 2 × 3 cm open wound with a small necrotic area on the great toe, accompanied by a second, smaller, similar lesion on the fourth toe. Physical examination and laboratory work-up, including a complete blood count, coagulation parameters, renal and hepatic parameters, and C-reactive protein, were unremarkable, and no systemic symptoms were present. The lesions were judged clinically compatible with cutaneous loxoscelism. She was treated empirically with oral cephalexin (500 mg three times daily for 7 days), topical wound spray, and hydrogel plus adhesive foam dressings, with scheduled dermatological and laboratory follow-up and explicit return precautions for systemic symptoms (nausea, jaundice, fever, abdominal pain) or lesion progression. Conclusions: Cutaneous loxoscelism should be considered in the differential diagnosis of necrotic skin lesions in Croatia. Compared with published cases, this patient had an unusually distal bite site (foot), no systemic involvement, and a favourable outcome with oral antibiotic and modern dressing therapy alone. In settings where specific antivenom is unavailable, early recognition, supportive wound care, and monitoring for the rare visceral (haemolytic–renal) form are the cornerstones of management.