Abstract：
A 63-year-old man presented with two days of palpable purpura over the right anterior shin and calf with notable point tenderness on the distal mid-calf without any palpable deep abnormality. Localized right calf pain worsened with walking and was associated with headache, chills, fatigue, and low-grade fevers. A punch biopsy of the anterior right lower leg showed necrotizing neutrophilic vasculitis of superficial and deep vessels. Direct immunofluorescence showed non-specific focal granular deposition of C3 within vessel walls. Three days after presentation, a live spider was found and microscopically identified as a male hobo spider. The patient suspected the spider arrived via packages shipped from Seattle, Washington. The patient was treated with a prednisone taper with full resolution of his cutaneous symptoms. Given the unilaterality of his symptoms and otherwise unexplained etiology, the patient was diagnosed with acute unilateral vasculitis secondary to hobo spider bite. Microscopic examination is required for identification of hobo spiders. Although not deadly, there have been several reports of cutaneous and systemic reactions resulting from hobo spider bites. Our case illustrates the importance of considering hobo spider bites in areas outside of their native regions, as they are known to travel in packaged items.
摘要：
一名63岁的男子在右前胫骨和小腿上出现两天明显的紫癜，在小腿中段远端有明显的点压痛，没有任何明显的深度异常。局部右小腿疼痛随着行走而恶化，并伴有头痛，发冷,疲劳,和低级发烧。右小腿前的穿刺活检显示浅表和深血管的坏死性中性粒细胞性血管炎。直接免疫荧光显示C3在血管壁内的非特异性局灶性颗粒沉积。陈述后三天，发现了一只活蜘蛛，并在显微镜下鉴定为雄性流浪汉蜘蛛。病人怀疑蜘蛛是通过从西雅图运来的包裹到达的，华盛顿。患者接受泼尼松锥度治疗，皮肤症状完全消除。鉴于他的症状的单方面性和其他原因不明的病因，该患者被诊断为继发于流浪汉蜘蛛咬伤的急性单侧血管炎。Hobo蜘蛛的鉴定需要显微镜检查。虽然不是致命的，已经有一些关于流浪汉蜘蛛咬伤引起的皮肤和全身反应的报道。我们的案例说明了在本土以外的地区考虑流浪汉蜘蛛叮咬的重要性，众所周知，它们以包装物品旅行。
