RESUMO
A 65-y-old previously healthy farmer developed thrombotic microangiopathy (TMA) comprising the triad of acute kidney injury, microangiopathic haemolysis, and thrombocytopenia after a proven Hypnale zara (hump-nosed pit viper) bite. He developed coagulopathy, which was treated with fresh frozen plasma, and underwent 8 cycles of hemodialysis. He is being followed up in the nephrology clinic for acute kidney injury. TMA caused by Hypnale hypnale, the commonest species of genus Hypnale, has previously been reported, but this is the first known case of TMA following a bite by H zara, the endemic species in Sri Lanka.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Anemia Hemolítica/induzido quimicamente , Mordeduras de Serpentes/complicações , Trombocitopenia/induzido quimicamente , Microangiopatias Trombóticas/induzido quimicamente , Venenos de Víboras/efeitos adversos , Viperidae , Injúria Renal Aguda/terapia , Idoso , Anemia Hemolítica/terapia , Animais , Humanos , Masculino , Sri Lanka , Trombocitopenia/terapia , Microangiopatias Trombóticas/terapia , Resultado do TratamentoRESUMO
There are 3 species of hump-nosed pit vipers in Sri Lanka: Hypnale hypnale, Hypnale zara, and Hypnale nepa. The latter 2 are endemic to the country. Microangiopathic hemolytic anemia (MAHA) is a known complication of hump-nosed pit viper bites. It was previously documented as a complication of general viper bites and not species specific. We report a series of 3 patients who developed MAHA after being bitten by each species of hump-nosed pit viper. The first patient was bitten by H hypnale and developed a severe form of MAHA associated with acute kidney injury and thrombocytopenia falling into the category of thrombotic microangiopathy. The other 2 developed MAHA that resolved without any complications.
Assuntos
Injúria Renal Aguda/diagnóstico , Anemia Hemolítica/diagnóstico , Crotalinae , Mordeduras de Serpentes/complicações , Injúria Renal Aguda/etiologia , Idoso , Anemia Hemolítica/complicações , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Especificidade da Espécie , Sri LankaRESUMO
A 74-year-old previously healthy woman was bitten by a hump-nosed pit viper (Hypnale hypnale) at dusk causing incoagulable blood lasting for 6 days. Further, she developed ecchymoses over her forearms, upper arms, hands, and lower back on day 4 after the snakebite, and microangiopathic hemolytic anemia (MAHA). Features of this nature are rare after hump-nosed pit viper bite.
