Neurotoxic presentation of Russell’s Viper bite case: A report from North India

Abstract

Russell’s Viper (Daboia russelii) is a highly venomous snake species prevalent in Southeast Asia. Russell’s viper is one of the “BIG FOUR” snakes responsible for most venomous bites and deaths in India. Envenomation in Russell’s viper bite is commonly associated with coagulopathy, renal dysfunction and local tissue damage. While hematological and nephrotoxic complications are well documented in Russell’s viper bite, neurological sequel as first presentation is rarely seen and reported. Neurological symptoms in Russell’s viper bite such as ptosis, opthalmoplegia and respiratory paralysis can mimic elapid envenomation and demand prompt identification and Anti Snake Venom (ASV) administration. We report a case of successful management of a patient presenting with neurotoxic features following Russell’s viper bite with a focus on early recognition, timely administration of ASV and supportive care   This is probably first report from North India of a Russell’s viper bite case presenting as neuropathy and is of high academic interest not only for clinicians but for venom analysis to find neurotoxins responsible.