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-
1.
Suraweera W et al.2020. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife 9: e54076.
-
2.
Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA , 2017. Snakebite envenoming. Nat Rev Dis Primers 3: 1–21.
-
3.
Sampley S, Sakhuja V, Bhasin D, Singh K, Singh H , 2020. Plasmapheresis for pulmonary hemorrhage following viperine snakebite: a case report with review of literature. Indian J Crit Care Med 24: 986–990.
-
4.
Bhatia S, Vasudevan K , 2020. Comparative proteomics of geographically distinct saw-scaled viper (Echis carinatus) venoms from India. Toxicon X 7: 100048.
-
5.
Gopalakrishnan M, Yadav P, Mathur R, Midha N, Garg MK , 2021. Venom-induced consumption coagulopathy unresponsive to antivenom after Echis carinatus sochureki envenoming. Wilderness Environ Med 32: 221–225.
-
6.
Kochar DK et al.2007. Rediscovery of severe saw-scaled viper (Echis sochureki) envenoming in the Thar desert region of Rajasthan, India. Wilderness Environ Med 18: 75–85.
-
7.
Bhatia S, Blotra A, Vasudevan K , 2021. Immunorecognition capacity of Indian polyvalent antivenom against venom toxins from two populations of Echis carinatus. Toxicon 201: 148–154.
-
8.
Senji Laxme RR et al.2019. Beyond the ‘big four’: venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies. PLoS Negl Trop Dis 13: e0007899.
-
9.
Park JA , 2021. Treatment of diffuse alveolar hemorrhage: controlling inflammation and obtaining rapid and effective hemostasis. Int J Mol Sci 22: 793.
-
10.
Noutsos T, Currie BJ, Lek RA, Isbister GK , 2020. Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis. PLoS Negl Trop Dis 14: e0008936.
-
11.
Rao IR, Prabhu AR, Nagaraju SP, Rangaswamy D , 2019. Thrombotic microangiopathy: an under-recognised cause of snake-bite-related acute kidney injury. Indian J Nephrol 29: 324.
-
12.
Padmanabhan A et al.2019. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 34: 171–354.
-
13.
Zengin S et al.2013. Plasma exchange as a complementary approach to snake bite treatment: an academic emergency department’s experiences. Transfus Apheresis Sci 49: 494–498.
-
14.
Srirangan A, Pushpakumara J, Wanigasuriya K , 2019. Pulmonary haemorrhage due to hump-nosed viper bite: excellent response to methyl prednisolone: case report and review of literature. J Trop Dis 7: 309.
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Case Report: Delayed Diffuse Alveolar Hemorrhage in Echis sochureki Envenoming, Jodhpur, India
Akhilesh Kumar
Akhilesh Kumar
Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India;
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Maya Gopalakrishnan
Maya Gopalakrishnan
Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India;
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Harshavardhan R. Kuri
Harshavardhan R. Kuri
Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India;
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Archana Bajpayee
Archana Bajpayee
Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Nikhil Kothari
Nikhil Kothari
Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India;
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Mahendra Kumar Garg
Mahendra Kumar Garg
Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India;
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ABSTRACT.
Snakebite envenoming is a common occupational hazard in the tropics. Venom-induced consumption coagulopathy and acute kidney injury are the most frequently encountered complications of viper bites. Diffuse alveolar hemorrhage (DAH) is an unusual presentation reported rarely in the literature. Our case report highlights the uncommon presentation of delayed pulmonary hemorrhage after snakebite envenoming. A 40-year-old healthy man presented to our emergency department after 6 hours of Echis sochureki (a saw-scaled viper subspecies) bite. He had abnormal coagulation parameters and thrombocytopenia with no signs of acute kidney injury. Transfusion protocols were initiated because of active bleeding and a rapid decrease in hemoglobin levels over next few days. Around day 10, his coagulation profile and hemoglobin were corrected, but he developed hemoptysis with rapidly progressive respiratory distress. Computed tomography of the chest was suggestive of DAH and the patient was started on plasma exchange with pulse methylprednisolone. After the initial worsening, he had rapid symptomatic improvement and radiological resolution. The patient had persistent hypofibrinogenemia, which resolved, and was discharged and remained healthy at the 60-day follow-up. This case highlights a presentation with an initial phase of venom-induced consumption coagulopathy followed by delayed DAH in saw-scaled viper envenoming that was treated successfully with immunosuppressants and plasma exchange.
Author Notes
Authors’ addresses: Akhilesh Kumar, Maya Gopalakrishnan, and Mahendra Kumar Garg, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India, E-mails: akhileshph@gmail.com, maya.gopalakrishnan@gmail.com, and mkgargs@gmail.com. Harshavardhan R. Kuri and Nikhil Kothari, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India, E-mails: harsha.kuri@gmail.com and drnikhilkothari@gmail.com. Archana Bajpayee, Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, India, E-mail: drarchanabajpai@yahoo.co.in.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Suraweera W et al.2020. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife 9: e54076.
-
2.
Gutiérrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA , 2017. Snakebite envenoming. Nat Rev Dis Primers 3: 1–21.
-
3.
Sampley S, Sakhuja V, Bhasin D, Singh K, Singh H , 2020. Plasmapheresis for pulmonary hemorrhage following viperine snakebite: a case report with review of literature. Indian J Crit Care Med 24: 986–990.
-
4.
Bhatia S, Vasudevan K , 2020. Comparative proteomics of geographically distinct saw-scaled viper (Echis carinatus) venoms from India. Toxicon X 7: 100048.
-
5.
Gopalakrishnan M, Yadav P, Mathur R, Midha N, Garg MK , 2021. Venom-induced consumption coagulopathy unresponsive to antivenom after Echis carinatus sochureki envenoming. Wilderness Environ Med 32: 221–225.
-
6.
Kochar DK et al.2007. Rediscovery of severe saw-scaled viper (Echis sochureki) envenoming in the Thar desert region of Rajasthan, India. Wilderness Environ Med 18: 75–85.
-
7.
Bhatia S, Blotra A, Vasudevan K , 2021. Immunorecognition capacity of Indian polyvalent antivenom against venom toxins from two populations of Echis carinatus. Toxicon 201: 148–154.
-
8.
Senji Laxme RR et al.2019. Beyond the ‘big four’: venom profiling of the medically important yet neglected Indian snakes reveals disturbing antivenom deficiencies. PLoS Negl Trop Dis 13: e0007899.
-
9.
Park JA , 2021. Treatment of diffuse alveolar hemorrhage: controlling inflammation and obtaining rapid and effective hemostasis. Int J Mol Sci 22: 793.
-
10.
Noutsos T, Currie BJ, Lek RA, Isbister GK , 2020. Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis. PLoS Negl Trop Dis 14: e0008936.
-
11.
Rao IR, Prabhu AR, Nagaraju SP, Rangaswamy D , 2019. Thrombotic microangiopathy: an under-recognised cause of snake-bite-related acute kidney injury. Indian J Nephrol 29: 324.
-
12.
Padmanabhan A et al.2019. Guidelines on the use of therapeutic apheresis in clinical practice: evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 34: 171–354.
-
13.
Zengin S et al.2013. Plasma exchange as a complementary approach to snake bite treatment: an academic emergency department’s experiences. Transfus Apheresis Sci 49: 494–498.
-
14.
Srirangan A, Pushpakumara J, Wanigasuriya K , 2019. Pulmonary haemorrhage due to hump-nosed viper bite: excellent response to methyl prednisolone: case report and review of literature. J Trop Dis 7: 309.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 9624 | 650 | 45 |
| Full Text Views | 222 | 48 | 0 |
| PDF Downloads | 96 | 9 | 0 |