Potentially fatal coagulopathy secondary to yamakagashi (Rhabdophis tigrinus) bites that completely recovered with antivenom treatment

摘要

Case A healthy 40‐year‐old man was admitted with severe coagulopathy that developed after R habdophis tigrinus bites. On admission, he showed significantly elevated levels of thrombin–antithrombin III complex (60?ng/ mL ), plasmin–alpha 2‐plasmin inhibitor complex (22.3?μg/ mL ), and fibrinogen degradation products (592?μg/ mL ). He subsequently developed severe hypofibrinogenemia (50?mg/ dL ). Outcome Antivenom was given 28?h after the patient was bitten, following which his hemorrhagic symptoms resolved. By day 3 of admission, scabs had formed over the bite wounds. Furthermore, his fibrinogen levels increased to 100?mg/ dL , while his thrombin–antithrombin III complex, plasmin–alpha 2‐plasmin inhibitor complex, and fibrinogen degradation product levels normalized. He was discharged on day 6 of admission. Conclusion Rhabdophis?tigrinus bites induced disseminated intravascular coagulation with a fibrinolytic phenotype, which completely recovered with antivenom treatment.