Case Report: Hemothorax in Envenomation by the Viperid Snake Bothrops asper

Luis José Pinto Hospital San Francisco, Juticalpa, Honduras;

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Linda Lee Fernández Hospital San Francisco, Juticalpa, Honduras;

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José María Gutiérrez Instituto Clodomiro Picado, San José, Costa Rica;

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Dany Samir Simón Hospital San Francisco, Juticalpa, Honduras;

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Ziomara Ceballos Hospital San Francisco, Juticalpa, Honduras;

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Luis Fernando Aguilar Hospital San Francisco, Juticalpa, Honduras;

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Manuel Sierra Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras

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Bothrops asper, a highly venomous pit viper distributed from Colombia and northwestern Peru in South America to southern Mexico, is responsible for most snake bites in Central America, affecting especially young agricultural workers. A 17-year-old male from a rural area in northern Honduras was admitted at San Francisco Hospital after a B. asper bite that had occurred 3 days earlier. The puncture wounds were located on the first toe of the right foot. On the second day of admission, the patient developed dyspnea. A physical examination revealed hypoventilation of the left lung with dullness on 75% of the left lung. Left pleural effusion, approximately 90%, was observed on the chest X-ray. The patient was diagnosed with hemothorax, and a thoracostomy drained 1,350 mL of serosanguineous fluid, followed by the installation of a wet suction control system (Pleur-evac®). After 10 days, the patient was discharged. This case illustrates the diversity of hemorrhagic manifestations in envenomations by B. asper.

Author Notes

Address correspondence to Luis José Pinto, Universidad Nacional Autónoma de Honduras, Boulevard Suyapa, Tegucigalpa, Honduras 11101. E-mail: luis.pinto@unah.hn

Authors’ addresses: Luis José Pinto, Emergency Department, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, Juticalpa, Honduras, E-mail: luis.pinto@unah.hn. Linda Lee Fernández, Emergency Department, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, San Pedro Sula, Honduras, E-mail: linda.fernandez@unah.hn. José María Gutiérrez, Instituto Clodomiro Picado, Universidad de Costa Rica, E-mail: jose.gutierrez@ucr.ac.cr. Dany Samir Simón, Hospital San Francisco, Universidad Nacional Autonoma de Honduras, Juticalpa, Honduras, E-mail: danyssa91@gmail.com. Ziomara Ceballos, Pediatrics Department, Hospital San Francisco, Catacamas, Honduras, E-mail: ziomaraceballos@yahoo.es. Luis Fernando Aguilar, Surgery Department, Hospital San Francisco, Tegucigalpa, Honduras, E-mail: fernando95215862@gmail.com. Manuel Sierra, Epidemiology Department, Universidad Tecnológica Centroamericana, Tegucigalpa, Honduras, E-mail: manuel.sierra@unah.edu.hn.

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