Saw scaled viper bite and envenomation in the subcutaneous plane.

Abstract

Dear Editor, We present a 25-year-old man bitten by a saw scale viper on his left hand. The patient presented to a medical emergency 4 hours after the bite. On examination, there was swelling, edema, and cellulitis in the left hand up to the axilla [Figure 1]. On laboratory evaluation, his Hb was 120 g/L, with a normal white cell count (9.0 × 109/L) and platelet 152 × 109/L, with coagulation showing normal reading (PT 12 s, INR, 0.98, APPT 29 s) and serum creatinine (88.42 umol/L). His 20-min whole blood clotting test was normal. Viper venom contains serine proteases, metalloproteinases, C-type lectins, and phospholipases and shows both procoagulant and anticoagulant effects on the blood clotting mechanism resulting in defibrination syndrome.[1] Among the toxins of saw-scaled viper, phospholipase helps in the subcutaneous spread of venom by dissolving the cell membrane. In the present case, envenomation was in the subcutaneous plane causing swelling, edema, and cellulitis. There was no systemic manifestation of envenomation. In such a scenario question arises whether to give antisnake venom or not when there is no defibrination syndrome or systemic manifestation of envenomation. In our patient, there was no coagulopathy at the time of admission and 24 hours after envenomation. But given local envenomation, it is decided to give antisnake venom. We gave 150 mL of antisnake venom over 8 hours. After that swelling started subsiding and over the next 24 hours, there was a significant decrease in swelling, cellulitis, and edema [Figure 2]. Giving antisnake venom in a locally toxic situation is beneficial and works by creating a concentration gradient across the extracellular compartment and sucking out intracellular venom and subsequent decrease in swelling, cellulitis, and edema.[2] Whenever there is local envenomation at the site of the bite by viper without systemic manifestation antisnake venom should be given.Figure 1: Envenomation in the left hand with swelling, edema, and cellulitisFigure 2: Swelling, edema, and cellulitis subsided after antisnake venomConsent Taken from the patient. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.