Haematemesis and Malaena - Rare Presentations of Methotrexate Toxicity - A Case Report

Aundhakar, Swati C; Bhalla, G B; Mhaskar, Dhanesh; Mane, Makarand; Panpaliya, N; Mahajan, Shweta

doi:10.5958/0973-9130.2014.00703.8

Cited by 3 publications

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“…This condition can be caused by various issues including bacterial and viral infections [ 3 , 4 ]. Optic neuritis and similar manifestations have been previously reported in some viper [ 5 , 6 , 7 ] and elapid [ 8 ] snakebite victims. However, the underlying molecular mechanisms that induce optic neuritis in snakebite victims were not completely understood.…”

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confidence: 76%

Reply to Jalink, M.B. Comment on “Senthilkumaran et al. Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait. Toxins 2022, 14, 805”

Senthilkumaran,

Miller,

Williams

et al. 2024

Toxins

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confidence: 76%

Reply to Jalink, M.B. Comment on “Senthilkumaran et al. Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait. Toxins 2022, 14, 805”

Senthilkumaran,

Miller,

Williams

et al. 2024

Toxins

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“…In addition to elapid snake species, some vipers such as Crotalus atrox (which is known to spit venom in some cases) [25,26], Daboia russelii [27], and Macrovipera lebetinus [28] as well as specific colubrid snakes were reported to induce optic neuritis [14]. In a Russell's viper bite victim, bilateral blindness developed within 30 min following the bite and improved upon treatment with methylprednisolone [27]. In contrast, Macrovipera lebetinus induced blurred vision and optic neuritis in a patient six days after the bite [28].…”

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Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait

Miller

Williams²,

Thirumalaikolundusubramanian

et al. 2022

Toxins

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In India, most snakebite envenomation (SBE) incidents are caused by the “Big Four” snakes which include Russell’s viper, common krait, Indian cobra, and saw-scaled viper. Their common envenomation effects include neurotoxicity, myotoxicity, and coagulopathy. However, they also induce rare complications such as priapism, pseudoaneurysm, and sialolithiasis. Ocular manifestations such as optic neuritis develop rarely following envenomations by non-spitting snakes and they may cause temporary vision changes and blindness if untreated. While optic neuritis following Indian cobra envenomation has been reported previously, this was not encountered in victims of common kraits. Hence, for the first time, we report optic neuritis developed in a victim following envenomation by a common krait and compare its clinical features and diagnostic and therapeutic methods used with another case of optic neuritis in a victim of an Indian cobra bite. Both patients received antivenom treatment and made an initial recovery; however, optic neuritis developed several days later. The condition was diagnosed using ophthalmic examination together with computed tomography and/or magnetic resonance imaging methods. Due to very similar clinical features, both patients received intravenous corticosteroids which restored their vision and successfully treated optic neuritis. This case report suggests that the optic neuritis developed in a common krait envenomation is comparable to the one developed following a cobra bite, and therefore, the same diagnostic and therapeutic approaches can be used. This study also raises awareness of this rare complication and provides guidance for the diagnosis and treatment of SBE-induced optic neuritis.

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Methotrexate overdose

2015

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Haematemesis and Malaena - Rare Presentations of Methotrexate Toxicity - A Case Report

Cited by 3 publications

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Reply to Jalink, M.B. Comment on “Senthilkumaran et al. Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait. Toxins 2022, 14, 805”

Reply to Jalink, M.B. Comment on “Senthilkumaran et al. Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait. Toxins 2022, 14, 805”

Bilateral Simultaneous Optic Neuritis Following Envenomations by Indian Cobra and Common Krait

Methotrexate overdose

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