The hump-nosed vipers which compromise ‘ Hypnale hypnale’, ‘H. zara’ and ‘H. nepa’ have been highly venomous snakes and ‘H. zara’ and ‘H. nepa’ are indigenous to Sri Lanka and ‘H. hypnale’ is endemic to Sri Lanka and India. The clinical presentations range from local swelling, blistering and necrosis at the site of bite with distinct fang marks to systemic envenomations such as coagulopathy, thrombotic microangiopathy, acute kidney injury and death in severe cases. Here, we report a case of thrombotic microangiopathy following hump-nosed viper ‘ Hypnale’ bite.

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Pyrexia of unknown origin is a challenging problem to the physicians and rarely endocrine causes such as subacute thyroiditis can present as a pyrexia of unknown origin. It is usually a self-limiting condition and following post viral inflammatory process. It is common in young adults to middle age and does not involve in any autoimmune pathology. It has a self-limiting nature and symptomatic treatment is adequate. We report a 34 year old presented with a one month history of fever found to have high ESR and CRP with high free thyroxine level and treated as subacute thyroiditis with NSAID and she recovered completely from the acute illness.

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