Benjamin Jordan Max, Chippaux Jean-Philippe, Jackson Kate, Ashe Sanda, Tamou-Sambo Bio, Massougbodji Achille, Akpakpa Olouchegoun Cardinal, Abo Benjamin N
J Spec Oper Med. 2019 Summer;19(2):18-22. doi: 10.55460/YQR3-UZJN.
A 20-year-old man presented to a rural hospital in Bembéréké, northern Benin, after a witnessed bite from a small, dark snake to his left foot that occurred 3 hours earlier. The description of the snake was consistent with several neurotoxic elapids known to inhabit the area in addition to various species from at least 10 different genera of non-front-fanged colubroid (NFFC) venomous snakes. The presentation was consistent with the early signs of a neurotoxic snakebite as well as a sympathetic nervous system stress response. Diagnosis was further complicated by the presence of a makeshift tourniquet, which either could have been the cause of local signs and symptoms or a mechanical barrier delaying venom distribution and systemic effects until removal. Systemic envenomation did not develop after the removal of the constricting band, but significant local paresthesias persisted for longer than 24 hours and resolved after the administration of a placebo injection of normal saline in place of antivenom therapy. This was an unusual case of snakebite with persistent neuropathy despite an apparent lack of envenomation and a number of snakebite- specific variables that complicated the initial assessment, diagnosis, and treatment of the patient. This case presentation provides clinicians with an opportunity to familiarize themselves with the differential diagnosis and approach to a patient bitten by an unidentified snake, and it illustrates the importance of symptom progression as a pathognomonic sign during the early stages of a truly serious snake envenomation. Treatment should be based on clinical presentation and evolution of symptoms rather than on snake identification alone.
一名20岁男子在被一条小的深色蛇咬伤左脚3小时后，被送往贝宁北部本贝雷凯的一家乡村医院。对这条蛇的描述与已知栖息在该地区的几种神经毒性眼镜蛇科蛇相符，此外还有至少10个不同属的非前沟牙游蛇科（NFFC）毒蛇的各种物种。其表现与神经毒性蛇咬伤的早期体征以及交感神经系统应激反应一致。由于存在一个临时止血带，诊断进一步复杂化，这个止血带要么可能是局部体征和症状的原因，要么是一个机械屏障，在去除之前延迟了毒液的分布和全身影响。去除束缚带后未发生全身中毒，但严重的局部感觉异常持续超过24小时，在注射生理盐水作为安慰剂而非抗蛇毒血清治疗后症状缓解。这是一例不寻常的蛇咬伤病例，尽管明显没有中毒，但仍有持续性神经病变，还有一些蛇咬伤特有的变量使患者的初始评估、诊断和治疗复杂化。本病例报告为临床医生提供了一个机会，使他们熟悉被不明蛇咬伤患者的鉴别诊断和处理方法，并说明了症状进展在真正严重蛇中毒早期作为诊断标志的重要性。治疗应基于临床表现和症状演变，而不仅仅基于蛇的鉴定。
