Successful use of anti-venom cross-neutralization effects in the clinical management of Shore Pit Viper envenomation

As the landscape becomes more urbanized, snakebites have increasingly become uncommon presentations to the emergency departments in Singapore, while snakebites causing significant envenomation are even rarer. In this case report, we discuss a 55-year-old man who had significant envenomation from a S...

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Bibliographic Details
Published in:The American journal of emergency medicine 2024-10, Vol.84, p.190.e1-190.e5
Main Authors: Kant, Abhay, Ng, Mingwei, Tan, Ming Jing Elizabeth, R., Assoc Prof Ponampalam
Format: Article
Language:English
Subjects:
Animals
Ankle
Antivenins - therapeutic use
Antivenom
Coagulation
Cross-neutralization
Crotalid Venoms - antagonists & inhibitors
Edema
Emergency medical care
Envenomation
Humans
Male
Middle Aged
Neutralization
Shore Pit Viper
Snake bites
Snake Bites - drug therapy
Snake Bites - therapy
Snakebite
Snakes
Toxicity
Toxins
Trimeresurus
Trimeresurus purpureomaculatus
Venom
Vital signs
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Summary:As the landscape becomes more urbanized, snakebites have increasingly become uncommon presentations to the emergency departments in Singapore, while snakebites causing significant envenomation are even rarer. In this case report, we discuss a 55-year-old man who had significant envenomation from a Shore Pit Viper (Trimeresurus Purpureomaculatus) and who was successfully treated with haemato-toxic polyvalent antivenom (HPAV). He initially presented with pain, swelling and bleeding over his wound. Due to a deterioration in his coagulation profile, he was given two doses of HPAV which is typically reserved for viperid snakes instead. Following administration of the anti-venom, the patient's coagulation profile improved, and the local soft tissue effects of the venom resolved. He did not manifest any adverse effects and was discharged uneventfully about 72 h after the snakebite. The cross-neutralization potential of HPAV for Shore Pit Viper (Trimeresurus Purpureomaculatus) venom in this case study suggests that there may be a possible common underlying chemical structure and pathophysiology among the venom proteins of various snake species. Given that Trimeresurus-specific antivenom is unavailable in most countries, this cross-neutralization strategy deserves further consideration and evaluation in similar circumstances.
ISSN:0735-6757
1532-8171
1532-8171
DOI:10.1016/j.ajem.2024.07.044