First reported case of systemic envenoming by the Sri Lankan keelback (Balanophis ceylonensis)

• Published in: Toxicon (Oxford) 2015-01, Vol.93, p.20-23
• Main Authors: Fernando, W.K.B.K.M., Kularatne, S.A.M., Wathudura, S.P.K., de Silva, A., Mori, A., Mahaulpatha, D.
• Format: Article
• Language: English
• Subjects: Adult; Animals; Balanophis ceylonensis; Blood Coagulation Disorders - etiology; Blood Coagulation Disorders - pathology; Coagulopathy; Colubrid; Colubridae; Elevated; Fibrin Fibrinogen Degradation Products - metabolism; Frozen; Headache; Headache - etiology; Headache - pathology; Hospitals; Humans; Infusion; International Normalized Ratio; Male; Males; Photography; Photophobia - etiology; Photophobia - pathology; Rhabdophis tigrinus; Secretions; Snake; Snake Bites - complications; Snake Bites - epidemiology; Snake Bites - pathology; Snakes; Sri Lanka - epidemiology; Sri Lankan keelback
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2014.11.219

Envenoming by colubrid snakes is rarely reported. However, some colubrid snakes (e.g. Rhabdophis tigrinus and Rhabdophis subminiatus) have caused severe systemic envenoming. We report here the first case of a bite with systemic envenoming by Balanophis ceylonensis, an opisthoglyphous natricine colubrid, in Sri Lanka. A 33-year-old healthy male field biologist was bitten while handling the snake for photography. Within 5 min of the bite on the dorsum of the right hand, he reported severe occipital headache, photophobia, chills and transient loss of consciousness. He vomited blood-stained gastric contents and bled from venepuncture sites. He had a markedly elevated INR and positive D-dimer test suggestive of significant coagulopathy that was treated with infusions of fresh frozen plasma. He recovered and left hospital after 96 h and subsequent investigations, including electroencephalogram, were normal. We conclude that B. ceylonensis should be regarded as a medically significant venomous snake. This case highlights the need for further studies of the oral secretions (venoms) of colubrid snakes. •Envenoming by colubrid snakes is rarely reported, but is attracting increased attention.•Balanophis ceylonensis, an opisthoglyphous natricine colubrid, endemic in Sri Lanka.•A 33-year-old healthy young male field biologist was bitten by B. ceylonensis on the hand.•He developed, severe headache, photophobia and severe coagulopathy.•This suggests B. ceylonensis is a medically significant venomous colubrid and needs venom studies.