Unusual neurological symptoms in a case of severe crotalid envenomation

In Sweden bites by non-European venomous snakes are reported to the Poison Information Centre 5-10 times annually. These incidents generally take place in private homes and may result in severe poisoning. We report a recent case of envenomation from a bite by Crotalus durissus terrificus with a prolonged, atypical course. The patient, a 24-year old man, was admitted to hospital approximately eight hours after the snakebite. On admission we noted coma, circulatory failure, hypofibrinogenaemia with bleeding from fang marks on his right arm, melaena and haematemesis. Antishock therapy including intravenous fluids, steroids and epinephrine was instituted immediately and within six hours infusion of polyvalent antivenom was started. Next day, when the initial disturbances were corrected, peripheral neurological features were noted and the patient gradually became comatose. Antivenin therapy was reinstituted. The coma lasted for one week and recovery extended over several months with persisting neurological symptoms. Six months after the bite there were still pathological findings in the electromyogram.