From Forest to Intensive Care Unit: Managing Severe Complications of Bothrops bilineatus Envenomation

Snakebites are a critical health issue in remote regions of the Amazon basin. I report a case of Bothrops bilineatus envenomation in a 29-y-old biologist conducting fieldwork in Parque Nacional del Manu, Peru. Following significant logistic delays-including an initial suboptimal antivenom dose and limited access to additional vials-the patient developed progressive edema, necrosis, coagulopathy, and signs of compartment syndrome. Management involved 2 partial doses of antivenom (1 at 1600 and the other at 2100), a subsequent transfer to a tertiary care center, antibiotics, analgesia, and eventually surgical intervention, including debridement and partial amputation. Although the patient received some treatment on the day of the bite, fragmented antivenom dosing and delayed transport likely contributed to worse local injury. This case highlights the importance of prompt, complete antivenom therapy, effective logistics, advanced diagnostic resources, and comprehensive rehabilitation in resource-limited settings.