Prakash Sudeep, Vikram Asturkar, Kashif A W, Khare Soumitra
Senior Advisor (Medicine) & Nephrology, Command Hospital (Southern Command), Pune, India.
Neurologist & Physician, Command Hospital (Southern Command), Pune, India.
Med J Armed Forces India. 2025 Jan-Feb;81(1):99-104. doi: 10.1016/j.mjafi.2023.11.004. Epub 2024 Jan 17.
Snake bite is a major cause of mortality in the Indian subcontinent. The condition is fraught with the problem of under reporting. Most bites in India are caused by the "Big 4 species," based on this, the anti-snake venom (ASV) is also sourced from these species only. It has been observed that the venom of snakes from different regions respond differently to it, as is sourced mainly from snakes of southern region of India. We present a case of a saw-scaled viper (SSV) bite, where the patient had unusual presentation of thrombotic microangiopathy (TMA) along with venom-induced consumption coagulopathy (VICC). The patient was resistant to ASV and finally succumbed. The snake was identified as (a subspecies of SSV). This case highlights that VICC is the commonest presentation in a SSV bite, rather than disseminated intravascular coagulation (DIC). The organ failure in such bites is due to rare coexistence of TMA (especially in an bite) and should not be attributed to DIC. It also identifies that the polyvalent ASV produced in India is not effective against bite.
蛇咬伤是印度次大陆死亡的主要原因之一。这种情况存在报告不足的问题。在印度，大多数咬伤是由“四大蛇种”造成的，基于此，抗蛇毒血清（ASV）也仅来源于这些蛇种。据观察，不同地区蛇的毒液对其反应不同，因为抗蛇毒血清主要来源于印度南部地区的蛇。我们报告一例锯鳞蝰蛇（SSV）咬伤病例，该患者出现了血栓性微血管病（TMA）以及毒液诱导的消耗性凝血病（VICC）的异常表现。患者对抗蛇毒血清耐药，最终死亡。该蛇被鉴定为（锯鳞蝰蛇的一个亚种）。该病例突出表明，VICC是锯鳞蝰蛇咬伤最常见的表现，而非弥散性血管内凝血（DIC）。此类咬伤导致的器官衰竭是由于TMA罕见共存（特别是在咬伤时），不应归因于DIC。它还表明，印度生产的多价抗蛇毒血清对咬伤无效。
