Report of a severe Heloderma suspectum envenomation

Heloderma bites are rare and generally mild, but a few cases can be life threatening.

We report a case of Heloderma suspectum envenomation in a healthy 39-year-old herpetologist. The patient rapidly developed tongue and lip swelling associated with stridor. On arrival at ICU, he was hypotensive, and in shock with atrial fibrillation requiring electrical cardioversion. Blood tests showed hypokalemia (2 mmol·L^-1), associated with moderate low blood electrolytes which were corrected rapidly. In addition, he presented hematological abnormalities (INR = 1.34 and fibrinogen levels at 80 mg·dL^-1) without active bleeding. All clinical and biological signs normalized without specific intervention and was discharged 4 days post-bite. The patient discharged 3 days after hospital presentation and fully recovered in 2 months.

The case presented here showed the three severe complications described after Heloderma bite: a) angioedema, b) fluid loss associated with hypokalemia and metabolic acidosis, and c) cardiac disorders simulating ischemia.