Manian Medical Centre, Erode, 638001, Tamil Nadu, India.
School of Pharmacy, University of Reading, Reading, RG6 6UB, UK.
Toxicon. 2023 Mar 15;225:107068. doi: 10.1016/j.toxicon.2023.107068. Epub 2023 Feb 28.
The clinical management of snakebite envenomation (SBE) is challenging in many tropical and subtropical regions of developing countries due to the complex clinical manifestations and inadequate medical infrastructure. Some venomous snakes, such as the Indian Russell's viper (Daboia russelii) cause a wide range of rare complications in addition to their classical envenomation effects. In general, these uncommon complications are often misdiagnosed or not treated promptly due to a lack of awareness about these conditions. Thus, it is critical to report such complications to draw the attention of the healthcare and research communities to improve the clinical management and scientific research of SBE, respectively. Here, we report bilateral adrenal and pituitary haemorrhages in an SBE patient following a bite by Russell's viper in India. The initial symptoms included gum bleeding, swelling, axillary lymphadenopathy and clotting abnormalities. Despite the administration of antivenom, the patient presented palpitation, nausea, and abdominal pain, which were not recovered by combinational therapy with epinephrine and dexamethasone. Further infusion of antivenom did not address these issues and the patient displayed persistent hypotension, hypoglycaemia and hyperkalaemia suggesting an adrenal crisis. Inadequate secretion of corticosteroids was confirmed by laboratory tests, and imaging investigations revealed haemorrhages in both the adrenal and pituitary glands. The patient made a full recovery after treatment with hydrocortisone and thyroxine. This report adds to the growing evidence of rare complications induced by Russell's viper envenomations and it provides relevant guidance to diagnose and treat such complications in SBE victims.
在发展中国家的许多热带和亚热带地区，由于临床表现复杂和医疗基础设施不足，蛇伤（SBE）的临床管理具有挑战性。一些毒蛇，如印度罗素蝰蛇（Daboia russelii），除了经典的蛇毒作用外，还会引起一系列罕见的并发症。一般来说，由于对这些情况缺乏认识，这些不常见的并发症往往被误诊或未能及时治疗。因此，报告这些并发症至关重要，以引起医疗保健和研究界的关注，分别改善 SBE 的临床管理和科学研究。在这里，我们报告了一名 SBE 患者在印度被罗素蝰蛇咬伤后出现双侧肾上腺和垂体出血。最初的症状包括牙龈出血、肿胀、腋窝淋巴结病和凝血异常。尽管给予了抗蛇毒血清，但患者出现心悸、恶心和腹痛，联合使用肾上腺素和地塞米松治疗后仍未恢复。进一步输注抗蛇毒血清并未解决这些问题，患者持续出现低血压、低血糖和高钾血症，提示发生肾上腺危象。实验室检查证实皮质激素分泌不足，影像学检查显示肾上腺和垂体均有出血。患者接受氢化可的松和甲状腺素治疗后完全康复。本报告增加了由罗素蝰蛇咬伤引起的罕见并发症的证据，并为 SBE 患者的此类并发症的诊断和治疗提供了相关指导。
