Vipera palaestinae bite and serum sickness during pregnancy

Vipera palaestinae is the most common venomous snake in Israel. We report a case of V. palaestinae bite and antivenom-induced serum sickness during pregnancy and discuss the unique considerations relevant to the treatment of a pregnant woman envenomated by a snake.

A 46-year-old woman, G6P5, 14 weeks gestation, was admitted after a V. palaestinae bite on her right toe. On admission to the Emergency Department, physical examination included the following vital signs and findings: pulse 76 beats/min, blood pressure 90/60 mm Hg, nausea, vomiting, foot and distal leg swelling, and normal fetal monitoring. She was treated with intravenous fluids, analgesics, and V. palaestinae antivenom. Eight days later she developed serum sickness, was treated with prednisone, and fully recovered. A healthy baby was born at term, with normal examination at 2 months post-delivery.

To our knowledge, this is the first reported case of V. palaestinae bite complicated by antivenom-induced serum sickness during pregnancy. No adverse pregnancy outcome due to the antivenom treatment or serum sickness was observed. Careful hemodynamic, hematologic, and obstetric monitoring (including ultrasound) of pregnant snakebite victims is warranted. Antivenom administration should be considered according to published indications to prevent maternal complications and fetal compromise. Patients treated with antivenom should be followed for possible development of serum sickness.