Serial envenomation in a snake handler with severe coaguloapathy

Abstract

We present a rare case study of a 37-year-old man with a history of multiple prior snake bites who presented to the emergency department for treatment of a rattlesnake bite to his right hand. Upon examination, he was found to be mildly hypertensive and exhibited significant coagulation abnormalities. Initial treatment included six vials of Crotalidae polyvalent immune fab; however, his coagulopathy was so severe that he required an additional eight vials. Continuous monitoring and calculations of Snakebite Severity Score demonstrated resolution of coagulopathy within 36 hours of admission. We believe the patient’s unusual recovery was likely due to an innate immune response, specifically an activated memory B-cell cascade. This case should lead researchers to consider that the resolution of severe coagulopathy might result from a memory-driven immune response in instances of multiple envenomations.

Keywords:

• Antibody response
• coagulopathy
• crotalid venom
• envenomation
• snakebite
• trained immunity

Disclosure statement/Funding

The authors report no funding. Alan Pang is a consultant for Exsurco Medical. John Griswold is a consultant for Exsurco Medical and a consultant for Medline. Akshay Raghuram and Theophilus Pham have no disclosures to report. The patient gave permission for this case to be published.