Thrombotic microangiopathy, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: Rare manifestations of Russell’s viper (Daboia russelii) envenoming in Sri Lanka
سال انتشار: 1400
نوع سند: مقاله ژورنالی
زبان: انگلیسی
مشاهده: 187
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شناسه ملی سند علمی:
JR_PJMT-10-3_008
تاریخ نمایه سازی: 11 مهر 1400
چکیده مقاله:
Background: Russell’s viper (Daboia russelii) of Family Viperidae is a highly venomous snake in Sri Lanka and is responsible for the most snakebite deaths. It commonly causes coagulopathy and neuroparalysis. Thrombotic microangiopathy (TMA) including the triad of acute kidney injury (AKI), thrombocytopenia and microangiopathic hemolysis is a rare complication of its bites. There are two clinical entities of TMA including hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) of which, only few records of TMA and HUS following Russell’s viper bites are available in literature.Case presentation: Two patients presented with TMA following Russell’s viper bites. A ۳۶-year-old male who got coagulopathy, respiratory failure, AKI, signs of HUS, and he completely recovered with antivenom and ۸ cycles of hemodialysis and discharged on day ۱۹ of snakebite. The other patient was a ۶۶-year-old female who had delayed coagulopathy and persistent drowsiness, the signs of TTP. She required antivenom with ۹ cycles of hemodialysis and ۶ cycles of therapeutic plasma exchange and got recovered after ۳۰ days in hospital that included intensive care treatments.Discussion: Russell’s viper venom causes activation of Factor V and X which results venom induced consumption coagulopathy and bleeding. The venom also blocks neuromuscular junction and causes neuroparalysis, which are commonly manifested as ptosis and external ophthalmoplegia. It also has direct nephrotoxic effects and there are fibrin depositions in renal microvasculature thereby, causing renal ischemia. In the spectrum of HUS-TTP of TMA, HUS is suggested when there is a severe renal involvement, and TTP is diagnosed when neurological impairment is prominent.Conclusion: Atypical presentations like TMA and HUS may rarely occur following Russell’s viper bites. Further evidence of similar observations is needed to confirm the clinical entity of TTP following Daboia russelii bites.
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نویسندگان
R.M.M.K.Namal Rathnayaka
Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura, Sri Lanka. Intensive Care Unit, Teaching Hospital, Ratnapura, Sri Lanka. Department of Veterinary Pathobiology, Faculty
P.E.A.N. Ranathunga
Medical Unit, Teaching Hospital, Ratnapura.
S.A.M. Kularatne
Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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