Vasculotoxic snake bite induced multi-organ dysfunction- A case report

Background: A WHO report included snake envenomation in the list of most important Neglected Tropical Diseases (NTD) and 95% of these cases were reported within developing countries. The reason behind this given importance is the high morbidity and mortality rates of snake envenomation as well as the challenges in availability and affordability of anti-snake venom [1]. Vasculotoxic snake bites has a myriad of manifestations ranging from local complications like necrosis and cellulitis to systemic complications such as coagulopathy, acute renal failure, acute respiratory failure, and hemolysis.  Case Presentation: We report a case of a young male patient who was bitten by a Russell viper snake and developed cellulitis and blackish discolorations of the local site. The patient developed altered sensorium and subsequent loss of consciousness with a CT scan of the brain showing intra-parenchymal and subarachnoid hemorrhage. The coagulation profile demonstrated disseminated intravascular coagulation. He was treated for the above complications with polyvalent anti-snake venom, fresh frozen plasma, and cryoprecipitate units. Three days later, the patient developed breathlessness and hemoptysis with a drop in haemoglobin level with bilateral parenchymal infiltrates and left lower lobe consolidation indicative of diffuse alveolar hemorrhage with acute respiratory distress syndrome. On the fifth day, the patient reduced urine output with raised serum and creatinine levels. The patient’s clinical status rapidly worsened despite mechanical ventilatory and inotropic support and unfortunately succumbed to death on the 7th day of admission. Conclusion: Although there are case reports of snake bite induced isolated organ involvement, little is known about multi-organ dysfunction due to snake envenomation. The widespread multi-systemic involvement of snake envenomation resulting in fatal intracranial hemorrhage, acute lung, and kidney injury in our patient has been illustrated in this case report.