RT Journal Article
SR Electronic
T1 A fatal outcome due to pulmonary hemorrhage following Russell’s viper bite
JF Saudi Medical Journal
JO Saudi Med J
FD Prince Sultan Military Medical City
SP 634
OP 637
DO 10.15537/smj.2015.5.10691
VO 36
IS 5
A1 Dhammika R. Palangasinghe
A1 Ranga M. Weerakkody
A1 Chamila G. Dalpatadu
A1 Christeine A. Gnanathasan
YR 2015
UL http://smj.org.sa/content/36/5/634.abstract
AB Russell’s viper (RV) envenomation causes local effects, coagulopathy, thrombosis, rhabdomyolysis, acute kidney injury, and neurological manifestations. Although coagulopathy and endothelial destruction causing local and mucosal surface bleeding is known, isolated severe pulmonary hemorrhage is not commonly reported. We report a previously healthy 18-year-old male who had bilateral severe pulmonary hemorrhages, which resulted in a fatal outcome following RV bite. This diagnosis was supported by persistent alveolar shadows, with minimum improvement despite hemodialysis without heparin, mixed acidosis and endotracheal tube bleeding. Other bleeding manifestations were absent. Polyvalent antivenom was administered in lieu of prolonged whole blood clotting time. Thrombocytopenia and mildly deranged clotting parameters were noted. Pulmonary hemorrhages were significant enough to require transfusion. This case highlights the importance of suspecting pulmonary hemorrhages in patients with alveolar shadows and desaturation following RV bite despite the absence of other bleeding manifestations in light of failure of optimum therapy including hemodialysis.