First report of a confirmed case of Montivipera latifii (Latifi's viper) envenoming and a literature review of envenoming by Montivipera species

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作   者：

Hassanian-Moghaddam H.;  Monzavi S.M.;  Shirazi F.M.;  Warrell D.A.;  Mehrpour O.; 

作者机构：

Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences;  Arizona Poison and Drug Information Center College of Pharmacy University of Arizona;  Department of Clinical Toxicology Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences;  Nuffield Department of Clinical Medicine University of Oxford; 

关键词：

Montivipera envenoming;  Montivipera latifii;  Viperidae;  Airway obstruction;  Snake bites;  Brain hypoxia; 

期刊名称：

Toxicon: An International Journal Devoted to the Exchange of Knowledge on the Poisons Derived from Animals, Plants and Microorganisms

i s s n：

0041-0101

年卷期：

2022 年 207 卷

页   码：

48-51

页   码：

摘   要：

© 2021Latifi's viper (Montivipera latifii), also known as Lar Valley or Damavandi viper, is endemic to Iran. It has rarely been recorded, as it occurs in a highly-protected national park. In this first clinical report of a confirmed bite by this species, a teenage girl was bitten on the chin, causing rapidly-progressive swelling of the face and oropharyngeal mucosa. At a local hospital, a misleading history given by the patient's relatives of a wasp sting and inadequate inspection of the bite wound misled the physicians from making the correct diagnosis, resulting in a considerable delay in the administration of antivenom. This allowed the development of partial obstruction of the upper airway causing respiratory distress. After transfer to a tertiary hospital, attempts at endotracheal intubation failed, necessitating tracheostomy, but this was not implemented early enough to prevent her developing respiratory failure and losing consciousness. After she was stabilized, snakebite envenoming was diagnosed by a clinical toxicologist who observed two fang puncture marks on her chin. This was later confirmed when a snake, identified as M. latifii, was discovered at the room where the bite had occurred. Her facial swelling and ecchymosis, attributable to envenoming, were effectively controlled by high-dose antivenom therapy. However, she did not recover consciousness, remaining in a vegetative state. About three weeks after the bite, she died as an indirect result of hypoxic brain damage complicated by septicemia. Prompt diagnosis, relief of upper airway obstruction and timely antivenom therapy might have prevented this tragic fatal outcome.