Loxosceles genus represents a wide number of species including the brown recluse spider. This spider is known worldwide for causing serious injuries resulting from its bite. The diagnosis of brown recluse spider bite is challenging as the injury clinically resembles other conditions and cannot be confirmed unless the spider was observed. We present a case of a 46-year-old male who presented to the emergency department with sudden onset of two painful punctate lesions. We discuss the clinical presentation, investigation and approach; additionally, we briefly highlight the main points with regards to presentation, diagnosis and management of this condition.

Introduction: Body stuffing is defined as ingesting small quantities of drugs in poorly sealed packets often to avoid repercussions from law enforcement. Cocaine is one of the drugs most commonly involved. Complications reported with stuffing include aspiration, esophageal obstruction and fatal toxicity. Survival from mechanical airway obstruction due to drug stuffing has not been reported. 

Case Report: In this article, we present a case of a 32-year-old male who was a cocaine body stuffer, complicated by agitated delirium, cardiotoxicity, and airway obstruction requiring resuscitation followed by a surgical tracheostomy to retrieve the obstructing cocaine bag. The patient’s hospital course was further complicated by rhabdomyolysis and acute kidney injury requiring dialysis. He was discharged in stable condition after a four-week hospital stay.

Conclusion: This case highlights the severe risks of cocaine body stuffing, including airway obstruction and cocaine-induced arrhythmias. Endotracheal intubation in such cases warrants a careful airway assessment to mitigate the risks of obstructive complications.