NEED TO KNOW
- Sarah Neal woke up with a mysterious bite that caused a rash and facial swelling, prompting a confusing trip to the ER
- Doctors first suggested it was a reaction to sunscreen or skincare, but her condition worsened
- Two dermatologists ultimately traced the cause to an extremely rare diagnosis — and TikTok helped her get the care she needed
What started as an ordinary night in rural Texas quickly spiraled into a baffling health scare that confounded doctors and captivated thousands.
In viral TikTok videos, Sarah Neal documented the moment her summer took a turn, from a strange crawling sensation on her skin to a rapidly spreading rash that would leave her nearly unrecognizable.
“I got bit at like two in the morning on a Friday, on my left butt cheek,” Neal tells PEOPLE. “I felt something crawling, reached down, grabbed it and threw it across the room.”
She didn’t think much of it the next day. But that night, during a movie with her husband, something strange started happening. “I told him, ‘Hey, my arms and legs are starting to get a rash,’ ” she recalls. “I looked in the mirror, and my face was bright red and hot to the touch.”
By the time they got home, she had a fever. Her skin was burning, and she started to feel alarmed.
The next morning, her face was swollen and puffy. It wasn’t just redness anymore — pustules were beginning to appear across her skin. “It felt like a really tight sunburn,” Neal says. “Everything was hot and tight, and I was so uncomfortable that I ended up going to the ER.”
But instead of finding clarity, she left the hospital more confused. Doctors dismissed the spider bite and didn’t give her a clear explanation.
“The ER was like, ‘This isn’t from a spider bite. We don’t know what it is,’ ” Neal tells PEOPLE. “They gave me steroids and antibiotics and just sent me on my way, and I felt kind of gaslit.”
At home, her mother stepped in and urged her to see a specialist. Neal listened and started calling around for a dermatologist appointment.
“My mom said, ‘You really need to get this checked. These pustules are concerning,’ ” Neal says. “I ended up finding someone who could see me the same day, which people on TikTok told me is almost impossible.”
The dermatologist examined her skin and listened to her story. What he said next caught her completely off guard. “He said it was an AGEP rash, which usually comes from antibiotics,” Neal explains. “But he told me there are really rare cases where it’s been triggered by a brown recluse spider bite.”
The bite mark on her skin matched what they typically see from that species. If the rash cleared up within five days of steroid treatment, that would confirm it. “That’s exactly what happened,” she says. “The rash started fading after the medication, and the bite area turned black and got hard.”
At the time, she hadn’t realized how serious it was. But comments from TikTok followers urging her to get medical help helped her see the full picture. “I didn’t think it was that big of a deal,” she says. “But it turned out the tissue around the bite was necrotic, basically dying, and I’m really grateful I listened and got it looked at.”
Before hearing the diagnosis, Neal says emergency room doctors offered a different theory. They thought it could be a reaction to sunscreen.
“I had borrowed [sunscreen] spray from a lifeguard and sprayed it all over my face before jumping in a lake,” Neal says. “Some of the ER doctors thought maybe that combination caused it.”
Though she considered it for a moment, she trusted the dermatologist more. With the bite, rash and swelling, all of it seemed to line up with the spider explanation. “I’ve learned not to spray body sunscreen on my face,” she adds with a laugh. “And I’m a big fan of clean products now.”
As the days passed, the bite itself got worse. The redness spread, and Neal could barely sit or be outside in the sun. “I live in a town with a population of 13, so I had to drive an hour into San Antonio to get a second opinion,” she says. “The pain was so bad, I couldn’t sit, and even laying in bed hurt.”
Her second dermatologist confirmed the same rare diagnosis. But this time, the warning was more serious.
“She told me the necrotic tissue was growing and that I probably shouldn’t go on my trip to Montana,” Neal says. “I had antibiotics and was trying to wait it out, but I also really didn’t want to cancel the trip.”
She returned to the ER again before leaving, hoping for reassurance. This time, the doctors told her the wound looked okay, and she was cleared to travel.
“Since then, it really did heal on its own,” she says. “I had pain meds, and after a while it scabbed, the scab fell off, and I slowly got back to my normal life.”
The recovery took time. Her skin took about a week to return to normal, and the pain in her lower back lasted a little longer. “It was about two weeks before I could sit without pain,” Neal says. “It was honestly the craziest two weeks of my life.”
Throughout the process, her dermatologists were fascinated by her case. Both told her they had only ever seen AGEP rashes from antibiotics and not spider bites. “One of them literally left the room to go look in his medical textbooks,” Neal says. “He came back and said there were a few cases just like mine, linked to brown recluse bites.”
The second dermatologist did the same thing. She returned to the room after doing her own research and confirmed the rare reaction. “I felt like I was a medical mystery,” Neal says. “They told me about other patients — like a 9-year-old and an older man — who had the same face reaction from a spider bite.”
She also had bloodwork done to check for complications. Some AGEP cases can lead to anemia, but her results came back mostly normal.
“They saw inflammation, which made sense,” Neal says. “But everything else looked fine, and I was just grateful to have answers.”
Once her story hit TikTok, thousands of people began commenting. Some had experienced similar reactions, and others simply offered support.
“Almost every comment was kind and trying to help in some way,” Neal tells PEOPLE. “Some advice was wild, someone told me to rub baking soda on my face, or use a credit card to slide off the pimples, but most people were really supportive.”
Neal has been on TikTok for years, but this video reached a new level of visibility. Now people still comment on her latest posts, telling her how great her face looks. “It’s been really comforting,” she says. “People have been so kind and encouraging through the whole thing.”
Looking back, Neal says sharing her story was more than just venting about a rash. It was a way to help others feel less alone and to remind people to trust themselves.
“I think it’s so important for doctors to stay up to date on rare reactions,” Neal says. “I’m glad there were records of this happening before, or I don’t know if anyone would’ve believed me.”
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Her advice for others facing uncertain symptoms is simple: speak up and keep pushing for answers. “If I didn’t book that dermatologist appointment, I never would’ve known what happened,” Neal says. “Especially as women, we have to advocate for ourselves because sometimes we’re not taken seriously.”
She remembers calling more than 10 places before someone agreed to fit her in. It was exhausting, she says, but it paid off. “People say I’m a hypochondriac, but I just like to be in tune with my body,” Neal says. “I knew something wasn’t right, and I’m glad I didn’t ignore it.”
Today, her skin is healed, and the pain is gone. All that remains is a small scar on her left side and maybe, someday, a little tribute. “I think I’m going to get a tattoo of a spider drawn on it,” she says, laughing. “Just for the memories.”
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