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Histopatholological Findings in a Fatal Case of Rinkhals Envenomation: A New Forensic Pathology Finding?
Jacob Joseph Moar1, Lawrence Hill, Michael Stewart
1From the *Division of Forensic Medicine and Pathology, and †Department of Chemical Pathology and Toxicology Unit, University of the Witwatersrand, Johannesburg, South Africa.
Insights
This case study details a fatal rinkhals (Hemachatus haemachatus) envenomation with a unique second bite. It highlights unusual spleen pathology and a novel brain hemorrhage finding in forensic pathology.
Area of Science:
- Forensic Pathology
- Toxicology
- Herpetology
Background:
- Cobra envenomation is a significant cause of mortality in Africa, India, and Sri Lanka.
- Histopathological documentation in forensic pathology reports for snakebites is often insufficient.
- Rinkhals (Hemachatus haemachatus) envenomation presents unique diagnostic challenges.
Observation:
- A fatal case of rinkhals envenomation involving a second bite on the same victim is presented.
- Histopathological examination of the spleen revealed findings that required differentiation between acute envenomation and immunostimulation from a prior bite.
- Extravasation of erythrocytes into Virchow-Robin spaces in the brain was observed, a finding not previously documented in snakebite cases.
Findings:
- The study addresses the ambiguity of splenic histopathology in cases of repeated envenomation.
- A previously undocumented neuropathological finding of erythrocyte extravasation into cerebral Virchow-Robin spaces was identified.
- This finding mimics traumatic brain injury, posing a diagnostic challenge for forensic pathologists.
Implications:
- Highlights the need for detailed histopathological reporting in snakebite fatalities.
- Suggests a potential misinterpretation of neuropathological findings in forensic investigations of snakebite.
- Emphasizes the importance of considering envenomation in differential diagnoses, even with seemingly trauma-related brain findings.
Abstract:
Although cobra envenomation continues to pose a threat to life and therefore constitutes a major cause of death in Africa, India, and Sri Lanka, the forensic pathology reports are not always histologically well documented or illustrated. The reports in the literature, although providing graphic evidence of the macroscopic appearances of the bite and its ensuing tissue necrosis, should the victim survive, often do not illustrate the histopathological findings to a sufficient degree. We present an unusual case of fatal envenomation by a rinkhals (Hemachatus haemachatus) in which the victim had been bitten a second time after a previous rinkhals' bite. Two issues therefore arose: (a) whether the histopathological findings in the spleen were an acute reaction to the snake bite or were due to immunostimulation as a consequence of the previously inflicted bite, and (b) the previously undocumented finding of extravasation of erythrocytes into the surrounding Virchow-Robin spaces in the brain, a finding usually associated with blunt head trauma and therefore interpreted as a cortical contusion hemorrhage by forensic pathologists.
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