Life-threatening green pit viper envenoming

Green pit viper bite is common in Myanmar. It has become increasingly recognized in hospitals, with an incidence of 5% of bites per year in 1998-2000. There have been few reported green pit viper bite cases, as most of the victims recovered and not life-threatening. This report presents a rare case of an adolescent male who expired from extensive tissue swelling and disseminated intravascular coagulation (DIC) after being envenomed by a green pit viper. There were few reported green snakebites in Myanmar. Clinical features of green pit viper (Trimeresurus erythrurus) bites were pain, local swelling and incoagulable blood. Systemic envenomed cases presented with vomiting, abdominal colic, sweating, hypotension and shock. Laboratory investigation showed thrombocytopenia, neutrophil leucocytosis, anaemia and raised blood urea. In Myanmar, two types of antivenom (Viper antivenom for Daboia siamensis and Cobra antivenom for Naja kaouthia) are produced from Myanmar Pharmaceutical Factory, Ministry of Industry. Currently, specific antivenom for green pit viper is not available and symptomatic treatment only can be given to green pit viper bite patients. A 13-year old boy living in a village (Thu Thaw Kone village) of Pathein, Ayeyarwady Region, was bitten on his bridge of nose by a green pit viper. He suffered pain at the bite site and swelling. The swelling gradually increased and dyspnoea started since evening of the day of bite. On admission, extensive tissue swelling and bruises on the head, upper chest, abdomen and knees were present. On the next day at 11:30 am, he suffered reduced urine output approximately 50 cc per 24 hr and so, was referred to Yangon General Hospital (YGH).