Acute kidney injury, coagulopathy, and deep vein thrombosis following a haemotoxic snakebite: A case report from a resource-limited setting

Abstract

Background

The green pit viper (Trimeresurus gramineus) is a venomous snake commonly encountered in South Asia, particularly in Bangladesh, and responsible for many snakebite incidents. Management of its envenoming is challenging due to the lack of a specific antivenom, requiring symptomatic and supportive care to address complications. The following case report represents the complexities in managing such envenomation with associated renal and venous thrombotic complications.

Case presentation

A 35-year-old female was admitted with left lower-limb swelling and ecchymosis following a snakebite. She was transferred from a primary-level hospital with acute kidney injury (serum creatinine 4.0 mg/dL) and venom-induced consumption coagulopathy (VICC) (high levels of d-dimer (15 mg/L), prothrombin time (28 seconds) and activated partial thromboplastin time (>120 sec). Duplex ultrasound confirmed presence of femoral vein thrombosis. The patient was treated with fresh frozen plasma along with other supportive measures. His renal function improved, with creatinine levels normalizing in days.

Conclusion

The management of green pit viper envenomation requires close monitoring of coagulation parameters and renal function, along with supportive care. The occurrence of unusual complications, such as deep vein thrombosis, necessitates a conservative and individualized approach to treatment. Further research is needed to better understand the pathophysiology and improve the therapeutic strategies for managing the sequelae of such envenomations.