Hump-nosed viper bite: an important but under-recognized cause of systemic envenoming

Shivanthan, Mitrakrishnan Chrishan; Yudhishdran, Jevon; Navinan, Rayno; Rajapakse, Senaka

doi:10.1186/1678-9199-20-24

Cited by 25 publications

(47 citation statements)

References 35 publications

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“…In our study, Russell's viper was the most common snake identified followed by HNP, and haemotoxic envenomation was the predominant type of envenomation, consistent with previously published reports. This finding merits attention because HNP has recently been identified as an important venomous snake in South India and Sri Lanka, responsible for venom-induced coagulopathy, and the currently available polyvalent ASV is ineffective against their envenomation 12 13…”

Section: Discussionmentioning

confidence: 99%

Snake bite mortality in children: beyond bite to needle time

Jayakrishnan

Mg²,

Krishnakumar³

et al. 2016

Arch Dis Child

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Section: Discussionmentioning

confidence: 99%

Snake bite mortality in children: beyond bite to needle time

Jayakrishnan

Mg²,

Krishnakumar³

et al. 2016

Arch Dis Child

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“…Although coagulopathy is reported frequently pulmonary haemorrhage is an unusual manifestation of humpnosed viper bite [3,4]. Here we report a patient who developed pulmonary haemorrhage which was successfully treated with systemic steroids.…”

Section: Introductionmentioning

confidence: 86%

A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

2020

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Background: Hump-nosed viper bite, the commonest venomous snake bite in Sri Lanka, is associated with significant morbidity. Specific anti-venom is not available for hump-nosed viper envenomation which is usually managed with supportive treatment. Pulmonary haemorrhage is an unusual manifestation of hump-nosed viper bite. Here we present a case of hump-nosed viper envenomation which complicated by pulmonary haemorrhage and was successfully treated with systemic steroids. To the best of our knowledge, it has not been reported in the literature before.Case presentation: A previously healthy 55-year-old man presented to the local hospital 18 h after a hump-nosed viper bite. He developed bilateral severe pulmonary haemorrhages, evidenced by rapid desaturation which needed intubation and mechanical ventilation, bleeding from the endotracheal tube and bilateral alveolar shadows in a chest x-ray. He had no other bleeding manifestations. Because of the life-threatening situation, he was treated with methylprednisolone pulse therapy. There was a rapid improvement of hypoxia with a resolution of x-ray changes. He was successfully weaned off from the ventilation after 24 h. Conclusion: This case highlights the importance of suspecting pulmonary haemorrhage in a patient who develops desaturation and alveolar shadow following hump-nosed viper bite even in the absence of other bleeding manifestation. Early and timely treatment with systemic steroid can be lifesaving in such patients.

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“…Clinical manifestations of local envenoming predominate during the early phase; the clinical manifestations include pain, swelling, tissue necrosis, and hemorrhagic blisters [ 4 ]. The commonest systemic manifestations include coagulopathy evidenced by spontaneous bleeding [ 3 ] and subclinical coagulopathy evidenced by altered coagulation profile [ 5 ] or features of thrombotic microangiopathy (TMA) [ 6 ]. Although the early reports from case series of patients with hump-nosed viper bites revealed a lack of systemic effects other than coagulopathy [ 7 ], it is now clearly recognized that hump-nosed viper bites can lead to a multitude of systemic envenoming features and even death [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the early reports from case series of patients with hump-nosed viper bites revealed a lack of systemic effects other than coagulopathy [ 7 ], it is now clearly recognized that hump-nosed viper bites can lead to a multitude of systemic envenoming features and even death [ 5 ]. Acute kidney injury was noted in up to 20% of cases in recent studies [ 5 ]. Neurological and cardiac effects are not well recognized in patients with hump-nosed viper bites and cardiac effects have been limited to transient electrocardiogram (ECG) changes according to the available literature [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarction associated with thrombotic microangiopathy following a hump-nosed viper bite: a case report

2017

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BackgroundHump-nosed viper bite is the commonest cause of venomous snakebite in Sri Lanka. Despite initially being considered a moderately venomous snake more recent reports have revealed that it could cause significant systemic envenoming leading to coagulopathy and acute kidney injury. However, myocardial infarction was not reported except for a single case, which occurred immediately after the snakebite.Case presentationA 50-year-old previously healthy Sri Lankan woman had a hump-nosed viper bite with no evidence of systemic envenoming during initial hospital stay. Five days later she presented with bite site cellulitis with hemorrhagic blisters, acute kidney injury, and evidence of microangiopathic hemolytic anemia and thrombocytopenia with normal coagulation studies. She was managed with supportive care that included intravenously administered antibiotics, blood transfusions, and hemodialysis; both her microangiopathic hemolytic anemia and thrombocytopenia improved without any specific intervention. On day 10 she developed: a non-ST elevation myocardial infarction complicated with acute left ventricular failure evidenced by acute shortness of breath with desaturation despite adequate ultrafiltration; new onset lateral lead T inversions in electrocardiogram; raised troponin I titer; and hypokinetic segments on echocardiogram. She was managed with low molecular weight heparin and antiplatelet drugs, which were later discontinued due to upper gastrointestinal bleeding. Her hospital stay was further complicated by hospital-acquired pneumonia and deep vein thrombosis involving her ileofemoral vein. She died on day 33 from the snakebite.ConclusionsMyocardial infarction after snakebites is rarely reported. This is the first case report of a patient developing a myocardial infarction during the recovery phase of thrombotic microangiopathy following a hump-nosed viper bite. The possibility of thrombotic risk related to thrombotic microangiopathy following hump-nosed viper bite is an area that is poorly studied; it needs further attention.

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Hump-nosed viper bite: an important but under-recognized cause of systemic envenoming

Cited by 25 publications

References 35 publications

Snake bite mortality in children: beyond bite to needle time

Snake bite mortality in children: beyond bite to needle time

A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

Acute myocardial infarction associated with thrombotic microangiopathy following a hump-nosed viper bite: a case report

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