I work at a clinic in a manufacturing plant and deal primari | Figure 1

I work at a clinic in a manufacturing plant and deal primarily with industrial accidents/injuries. a week ago 63yo F security guard came in stating she was bit by a spider 2 days ago and it's gotten worse since. I asked her if she saw the spider bite her and she states she did not.

We have brown recluse and black widows here but i have never seen a spider bite present like this. I probed for more information and she reported that she was jobless for 2 years until last week and is currently at a homeless shelter. She denies any other lesions. Denies generalized symptoms (chills, aches, HA, abdominal cramping or pain, vomiting, etc).

The images are progress over a week. Taken 2-3 days apart each. Tenderness along the superior border has improved consistently. I'd like to refer her out but she has opted against twice now.

What infections should be in my differential?

Similar cases

\n\n20F with sudden pain and tenderness at this site. The smaller outlined area is what I am thinking is the actual bite site. Pt went to a walk in urgent care x2 days ago and was told if the area got darker or bigger to call EMS. Per the pt it has gotten significantly darker. All vitals stable. Area is still painful to touch. Any thoughts? #Spider-bites](https://app.figure1.com/case-detail/119dd30e-7b6c-4b06-bd9b-0a28d8e570df)

\n\nBrown recluse spider bite. Pt came in 2-3 weeks after bite.](https://app.figure1.com/case-detail/2756e8aa-ef93-41cf-8c26-efbe987cd8ca)

\n\nSpider bite unknown origin](https://app.figure1.com/case-detail/2dcbd73e-728d-4f71-915c-81458efad711)

\n\nThis is a 65 yo-M who presented with a bug bite (he said spider, but didnt see what bit him) that happened about 2 weeks ago, at first it was itchy but and was slightly red. 1 week ago, it started to swell like this. But per patient it is getting better. There was white floaters inside the fluid.](https://app.figure1.com/case-detail/2efe7784-affd-4e10-854a-babb9d0e0cf6)