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15 April 2020 : Case report  Jordan

Thrombotic Microangiopathy Following Arabian Saw-Scaled Viper (Echis coloratus) Bite: Case Report

Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care

Mohammad Bader Obeidat1ABDEF*, Ali Mohammad Al-Swailmeen1B, Mohammad Mahmoud Al-Sarayreh2B, Khaldoun Mohammad Rahahleh2B

DOI: 10.12659/AJCR.922000

Am J Case Rep 2020; 21:e922000

Abstract

BACKGROUND: Consumption coagulopathy post envenomation is one the most common complications after a snakebite. It occurs secondary to activation of a coagulation cascade by snake venom and could be followed by a syndrome consistent with thrombotic microangiopathy. The efficacy of plasma exchange for the treatment of thrombotic microangiopathy post envenomation is a matter of debate.

CASE REPORT: We reported the case of a 50-year-old male who had Arabian saw-scaled viper envenomation. He developed venom induced coagulopathy that improved within 24 hours of antivenom therapy. He subsequently developed micro-angiopathic hemolytic anemia, thrombocytopenia, and renal failure that was consistent with thrombotic microangiopathy. The patient was treated by plasma exchange and hemodialysis. He made a full recovery and was discharged after 4 weeks.

CONCLUSIONS: This case report supports plasmapheresis as an option for management of a patient who develops thrombotic microangiopathy secondary to snake bite, especially those who do not improve with antivenom and supportive therapy.

Keywords: Acute Kidney Injury, Disseminated Intravascular Coagulation, Plasmapheresis, Renal Dialysis, Snake Bites, Thrombotic Microangiopathies, Middle Aged, Plasma Exchange, Viper Venoms, Viperidae

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923