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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 Obeidat, Ali Mohammad Al-Swailmeen, Mohammad Mahmoud Al-Sarayreh, Khaldoun Mohammad Rahahleh

Jordan Department of Medicine, Royal Medical Services, Amman, Jordan

Am J Case Rep 2020; 21:e922000

DOI: 10.12659/AJCR.922000

Available online: 2020-03-04

Published: 2020-04-15


#922000

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



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