One Bite, Two Severe Envenomations Despite Antivenom Therapy: A Case Report.

Area of Science:

• Clinical Toxicology
• Neurotoxicology
• Herpetology

Background:

• Cobra envenoming can cause severe neurotoxicity and local tissue damage.
• Delayed or recurrent neurotoxic symptoms may occur even after antivenom administration.
• Effective management requires a comprehensive approach addressing systemic and local effects.

Purpose of the Study:

• To report a case of a pediatric patient with delayed, biphasic neurotoxic episodes following a cobra bite.
• To emphasize the role of supportive care, including neostigmine, in managing severe neurotoxic symptoms.
• To highlight the importance of prompt wound management and inter-departmental collaboration in preventing complications.

Main Methods:

• Case report of a 12-year-old child with confirmed cobra envenoming.
• Administration of specific antivenom and supportive care.
• Monitoring for systemic and local envenoming, including neurotoxic manifestations.
• Use of neostigmine for managing severe neuromuscular weakness.

Main Results:

• The patient developed severe local envenoming and two distinct episodes of systemic neurotoxicity 19 hours apart.
• Antivenom administration did not prevent the biphasic neurotoxic events.
• Neostigmine administration led to improvement of severe symptoms.
• The patient recovered fully with no long-term complications due to prompt and coordinated care.

Conclusions:

• Recurrent neurotoxicity is a potential complication of cobra envenoming, necessitating prolonged observation.
• Neostigmine can be effective in managing severe neurotoxic symptoms in pediatric snakebite victims.
• Multidisciplinary care and vigilant wound management are essential for optimal outcomes in severe envenoming cases.