An unusual case of hump-nosed-viper bite complicated with venom-induced thrombotic thrombocytopaenic purpura

Abstract

Abstract Background: Hump-nosed-viper bites are common in Sri Lanka resulting in nephrotoxicity and coagulopathy. Venom induced consumptive coagulopathy (VICC) is a known complication which occurs in absence of nephrotoxicity. Case Presentation: We report a case of hump-nosed-viper bite complicating with venom-induced thrombotic thrombocytopenic purpura (VITTP) of a 49 years old previously healthy male. Following envenomation, he developed anuria with acute kidney injury. The blood picture showed microangiopathic haemolytic anaemia with thrombocytopenia while the clotting profile was normal. A plausible diagnosis of VITTP was made per a high PLASMIC score (6/7). The patient underwent therapeutic plasma exchange (TPE) followed by high dose steroids along with renal replacement therapy. He made a full recovery. Conclusion: VITTP is a manifestation that needs to be differentiated from VICC in hump-nosed-viper bites.