A CASE OF VIPER SNAKE BITE PRESENTING WITH GANGRENE AND SEPSIS ASSOCIATED MULTIORGAN FAILURE, SUCCESSFULLY TREATED WITH CYTOSORB® AS AN ADJUNCT THERAPY- A CLINICAL EXPERIENCE
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 6
Abstract
PRESENTATION OF CASE Viper snake bites are known to cause local complications like necrosis and cellulitis and systemic complications such as coagulopathy, acute renal failure (ARF), and haemolysis. We report a case of 32-year young male patient who was bitten by a viper. He developed cellulitis, sepsis, acute renal failure, and disseminated intravascular coagulation (DIC). Patient also developed acute respiratory distress syndrome (ARDS) probably due to the direct toxic effect of venom on pulmonary vascular endothelium. He was treated with standard care of treatment along with a novel extracorporeal cytokine adsorption device Cytosorb® as an adjunct therapy. After Cytosorb® treatment, all his renal, haematological and respiratory parameters returned to normal. The post-Cytosorb® APACHE II and SOFA score was reduced to 11 and 8 from a baseline value of 29 and 15 respectively. A 32-year-old male was admitted with the history of snake bite over the dorsal surface of right lower limb. The snake in this case was identified as a viper. He was immediately treated with polyvalent anti snake venom (ASV) elsewhere in local hospital. After few days, he was admitted to our hospital having developed extensive cellulitis leading to necrotizing fasciitis of right lower limb. There was wet gangrene of the right lower limb up to the knee level. A clinical diagnosis of limb gangrene with septicaemia was entertained. Lower limb amputation was performed. He was optimized (fluid resuscitation, blood transfusion, tetanus toxoid administration, ceftriaxone and combination of antibiotics) for an emergency in surgery unit. Following amputation, patient was drowsy, hypotensive and in septic shock condition. Patient was shifted to ICU. The sepsis severity score i.e. APACHE II and SOFA on ICU admission were 29 and 15 respectively.
Authors and Affiliations
Rajib Paul, Brajesh Kumar Jha, Vikram Kumar Shetty
Keywords
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- EP ID EP454164
- DOI 10.18410/jebmh/2018/114
- Views 83
- Downloads 0
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