Citation

Ganguly D, Ghosh S, Dutta S, Chandra A. BMJ Case Rep. 2022; 15(10): e252217.

Copyright

(Copyright © 2022, BMJ Publishing Group)

DOI

10.1136/bcr-2022-252217

PMID

36223976

Abstract

A male patient in his 40s was admitted to our facility 8 hours following a Russel's viper (Daboia russelii) bite over the dorsum of the left foot. He was referred to our hospital from a primary healthcare centre after receiving 10 vials of antisnake venom (ASV). On admission, he complained of progressive local swelling which had crossed the proximal ankle and knee joint. A 20 min whole blood clotting test done at bedside was positive. Based on these findings, another 20 vials of ASV were given. Basic blood parameters on admission revealed neutrophilic leucocytosis (total leucocyte count of 22.6×109/L; neutrophil 78%, lymphocyte 19%), slightly raised urea (15.7 mmol/L, reference range 2.1-8.5), creatinine (133 μmol/L, reference range 59-104), a deranged prothrombin time (17 s, reference range 11.0-13.5) and activated partial thromboplastin time (45 s, reference range 30-40). Intravenous antibiotics (meropenem 1 g three times a day and metronidazole 500 mg three times a day) were started.

On the second day of admission, he developed bilateral painful parotid swelling and subconjunctival haemorrhage (figure 1) Ultrasonography of the parotids confirmed enlargement. The other salivary glands were normal on examination. On enquiry, the patient confirmed that there was no such swelling in the past. From day 3, the patient had developed haematuria, oliguria and rising urea/creatinine levels. Haemodialysis was initiated for oliguric acute kidney injury (AKI). There was further derangement of his coagulation profile, for which 8 units of fresh frozen plasma was administered. However, in spite of our best efforts, the patient died on day 4 of admission secondary to sepsis, AKI and disseminated intravascular coagulation...

Language: en

Keywords

Poisoning; Public health; Toxicology; General practice / family medicine