Favorable Course after a Second Infusion of Antivenin Using Premedication

Abstract

An 80-year-old woman had suffered a mamushi bite to the left hand 3 days ago and visited a local hospital. She was admitted for observation but received only tetanus toxoid, antibiotic and cepharanthine. Physicians hesitated to administer antivenin due to the risk of severe side effects, as she had previously received antivenin for mamushi bite at 50 years old. On the third day, the swelling had reached her left chest (grade V), so she was transferred to our hospital via ambulance. She had two bite wounds from a mamushi on her left hand and showed swelling with subcutaneous hemorrhaging from the finger to her chest and upper back. Chest computed tomography showed left pleural effusion. She underwent infusion of mamushi antivenin after premedication using a subcutaneous injection of 0.3 mg of adrenaline and drip infusion of 10 mg of chlorpheniramine, 20 mg of famotidine and 100 mg of hydrocortisone. She was not complicated with an anaphylactic reaction. After the infusion of the antivenin, her swelling and pleural infusion gradually improved, so she discharged on the seventh hospital day. Even after discharge, she showed no complication with serum sickness. This case showed a favorable course after a second infusion of antivenin using premedication. As there have been few reports of multiple infusions of antivenin for the same patient, a further analysis with the accumulation of similar cases is necessary.