Abstract

Introduction Venom-specific immunoglobulin G fragments are used for the management of patients with North American crotalid envenomation. In this case, ongoing coagulopathy and clinically significant sequelae required a protracted course of antivenom therapy in a patient experiencing severe rattlesnake envenomation. Case A 51-year-old male presented with breathing difficulties, hypotension, and coagulopathy following envenomation of his right forearm by an Eastern Diamondback rattlesnake (C. adamanteus). He required intubation, blood products, and an initial 10-vial dose of antivenom (CroFab®). On hospital day 2, the patient was considered to have completed antivenom therapy after receiving 34 vials. However, due to recurrent coagulopathies the patient ultimately received 45 antivenom vials, with a final dose 12 days after envenomation. His 30-day hospitalization was complicated by kidney injury requiring continuous renal replacement therapy, pneumonia, and the need for vasopressor support. Conclusion Antivenom may be effective for treating patients with delayed, recurrent coagulopathy subsequent to a large envenomation and circulatory collapse.

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