Venom-induced myocarditis: An unusual case attributable to Vipera aspis bite

Area of Science:

• Cardiology
• Toxicology
• Medical Emergencies

Background:

• Venomous snake bites are medical emergencies with potential for severe systemic effects.
• Cardiovascular complications, though uncommon, require early detection and management.
• Myocarditis following viper envenomation is exceptionally rare in human cases.

Observation:

• A 33-year-old reptile zoo keeper experienced a Vipera aspis bite, leading to angioedema, compartment syndrome, and severe hematologic abnormalities.
• The patient exhibited hemodynamic instability, ECG changes (ST depression), pericardial effusion, and elevated troponin T.
• Cardiac MRI confirmed intramyocardial edema and inflammation consistent with myocarditis.

Findings:

• This case presents documented viper bite-induced myocarditis in Europe, diagnosed via echocardiography and cardiac MRI.
• The patient's condition improved significantly following administration of antivenom.
• Diagnostic imaging revealed septal and anterior intramyocardial edema without late gadolinium enhancement.

Implications:

• Highlights the importance of recognizing rare cardiovascular complications, such as myocarditis, after snake envenomation.
• Emphasizes the critical role of prompt antivenom administration in managing severe viper bites.
• Underscores the need for vigilance regarding snakebite severity, irrespective of geographic latitude.