Reversible myocarditis following Black widow spider (Latrodectus spp.) bite in Egypt

Black widow spiders (BWSs) are poisonous spiders of the Arthropoda phylum that live in the Mediterranean region. The effects of BWS bites ranges from local damage to systemic manifestations including paresthesia, stiffness, abdominal cramps, nausea, vomiting, headache, anxiety, hypertension, and tachycardia. However, cardiac involvement following a BWS bite is uncommon. We report a 35-year-old man who developed acute pulmonary edema with electrocardiogram changes that showed ST elevation in leads I, aVL with reciprocal ST segment depression in infero-lateral leads with elevated cardiac biomarkers. Echocardiography showed regional wall motion abnormalities with an impaired ejection fraction of 40%. The condition was reversible after one week of supportive treatment, and the patient was discharged from the hospital with normal electrocardiogram, ejection fraction, and negative cardiac markers. A routine cardiac evaluation, serial ECG, serial cardiac markers, and echocardiography follow-up should be considered for any patient exposed to a BWS bite for detection of any potentially fatal cardiac abnormalities. Keywords: Black widow spider; Egypt; Spider bites; Myocarditis; Heart failure; Kounis syndrome; Acute coronary syndrome.