Severe Snakebite Envenomation: A Near-fatal Case Of Probable Antivenom Inefficacy

Abstract

Snakebite envenomation constitutes a major healthcare problem in Nigeria and the outcome of this medical emergency may be influenced by the prompt administration of efficacious antivenom. The carpet viper (Echis ocellatus) is responsible for majority of snakebite envenomation in Nigeria and the clinical manifestation includes coagulopathy, local swelling, pain and sometimes tissue necrosis. Snake antivenoms are the mainstay of treatment and the use of ineffective brands may lead to untoward outcomes. We present a 21 year old female student who had snake bite to the foot and subsequently developed systemic envenomation characterized by severe bleeding disorder. She was treated with a total of 30 vials of Asna Antivenom C (brand of antivenom by Bharat Serum and Vaccines Ltd, India) over five days without improvement. She was then switched to EchiTab-Plus-ICP (brand of antivenom by Instituto Clodomiro Picado, Costa Rica), following which coagulopathy rapidly resolved with 8 vials of EchiTab-Plus-ICP. This case describes the potential harm of antivenom inefficacy and suggests an urgent need for a study on the comparative potencies of available snake antivenoms in Nigeria.

Keywords: Snakebite, Envenomation, Echis ocellatus, Coagulopathy, Antivenom