Which envenomation is most commonly associated with necrotic tissue at the bite site?

• A. Brown recluse
• B. Black widow
• C. Coral snake
• D. Scorpion sting

Answer: (A)

Necrosis at the bite site is most strongly linked to brown recluse envenomation. The venom contains sphingomyelinase D, which damages cell membranes and triggers local tissue destruction, leading to a necrotic eschar that can ulcerate over days. By contrast, black widow venom is primarily neurotoxic, causing intense pain, cramps, and autonomic symptoms rather than tissue death; coral snake venom is also neurotoxic, leading to weakness and paralysis; scorpion venom often causes pain and possible systemic effects but not characteristic necrosis of the bite area. So, the presence of a developing necrotic lesion at the bite site points best to a brown recluse bite.