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Thrombotic microangiopathy following Bothrops jararaca snakebite: case report
Fábio Bucaretchi1,2, Maíra M Branco Pimenta2, Carla F Borrasca-Fernandes1,2
1a Department of Pediatrics, School of Medical Sciences , State University of Campinas (UNICAMP) , Campinas , Brazil.
Clinical Toxicology (Philadelphia, Pa.)
|November 17, 2018
Summary
Thrombotic microangiopathy (TMA) following a snakebite from Bothrops jararaca is rare but severe. This case demonstrates a patient who recovered fully with conservative management, highlighting the potential for good outcomes in this uncommon complication.
Area of Science:
- Toxicology
- Hematology
- Nephrology
Background:
- Thrombotic microangiopathy (TMA) is a rare but serious complication of snakebites, presenting similarly to hemolytic-uremic syndrome (HUS).
- Envenomation by Bothrops jararaca can lead to severe hematological and renal complications.
Observation:
- A 56-year-old woman developed TMA after a Bothrops jararaca bite, characterized by coagulopathy, thrombocytopenia, anemia, and acute kidney injury.
- The patient exhibited fragmented red blood cells, haptoglobin consumption, and elevated lactate dehydrogenase, consistent with microangiopathic hemolytic anemia.
- Despite severe symptoms, including KDIGO stage 3 acute kidney injury, the patient received conservative treatment with antivenom and fluid replacement.
Findings:
- The patient experienced progressive improvement starting on day nine and was discharged on day 20, with complete recovery of hemoglobin levels by day 50.
- ADAMTS-13 activity was within normal limits 10 months post-bite, ruling out typical thrombotic thrombocytopenic purpura (TTP).
- This case highlights that conservative management can lead to a favorable outcome in TMA secondary to Bothrops jararaca envenomation.
Implications:
- This case underscores the importance of recognizing TMA as a potential complication of Bothrops jararaca snakebites.
- Conservative management, including antivenom and supportive care, can be effective in treating snakebite-induced TMA, even in severe cases.
- Further research into the specific mechanisms and optimal management strategies for TMA in snakebite victims is warranted.
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