Envenoming by Viridovipera stejnegeri snake: a patient with liver cirrhosis presenting disruption of hemostatic balance

 

Chih-Ying Chien¹, Shu-Chen Liao², Chien-Hung Liao³, Ting-Shuo Huang¹, Yu-Hsien Chen¹

 

1 Department of General Surgery, Chang-Gung Memorial Hospital, Keelung Branch, 222, Maijin Road, Keelung, Taiwan.

2 Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.

3 Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.

 

ABSTRACT

Background

In most cases of envenoming by the green habu Viridovipera stejnegeri in Taiwan coagulopathy is not observed.

 

Case presentation

Herein, we describe the case of a patient with liver cirrhosis who developed venom-induced consumptive coagulopathy after V. stejnegeri bite. Laboratory investigation revealed the following: prothrombin time > 100 s (international normalized ratio > 10), activated partial thromboplastin time > 100 s, fibrinogen < 50 mg/dL, and fibrin degradation product > 80 μg/mL. The patient recovered after administration of bivalent hemorrhagic antivenom, vitamin K, fresh frozen plasma and cryoprecipitate.

 

Conclusion

The liver, directly involved in the acute phase reaction, is the main responsible for neutralization of animal toxins. Any patient with history of liver cirrhosis bitten by a venomous snake, even those whose venoms present low risk of coagulopathy, should be very carefully monitored for venom-induced consumptive coagulopathy (VICC), since the hemostatic balance may be disrupted.

 

Key words: Snakebite; Liver cirrhosis; Coagulopathy.

 

Received: September 27, 2016.

Revised: January 19, 2017.

Accepted: February 14, 2017.

 

Correspondence: hjjiimm@hotmail.com

 

Authors’ contributions

CYC, TSH and YHC were responsible for the conception and design of the case report and analysis of the data. SCL contributed to drafting the article and revising it critically for important intellectual content. CHL was responsible for the editing the final version of the manuscript. All authors read and approved the final manuscript.

 

Competing interests

The authors declare that they have no competing interests.

 

Consent for publication

Written informed consent was obtained from the patient for publication of this case report.

 

Ethics approval and consent to participate

The present study was approved by the Institutional Review Board of Chang Gung Medical Foundation, Taiwan.