Citation

Krishnan M, Janaka K, Hussain H, Fernando H, Kariyawasan C. Cureus 2024; 16(3): e55873.

Copyright

(Copyright © 2024, Curēus)

DOI

10.7759/cureus.55873

PMID

38618402

PMCID

PMC11015824

Abstract

Thrombotic thrombocytopenic purpura (TTP) is one of the rarely encountered complications of hump-nosed viper bites, which requires early detection and specific management. Hump-nosed viper bites are well known to affect multiple systems, and it is imperative to identify and manage each complication simultaneously. A 48-year-old patient presented to the hospital following a hump-nosed viper bite, where he subsequently developed local necrosis, acute kidney injury (AKI), and TTP. A diagnosis of TTP was made using the PLASMIC score (which refers to the score's seven components: platelet count; combined hemolysis variable; absence of active cancer; absence of stem-cell or solid organ transplant; mean corpuscular volume (MCV); international normalized ratio (INR); and creatinine) and supporting blood picture findings despite the diagnostic difficulties encountered due to the misleadingly normal automated platelet counts. The patient underwent multiple blood transfusions, 12 cycles of hemodialysis, and two cycles of therapeutic plasma exchange, the latter contributing to a significant improvement in his overall clinical and biochemical markers. In this case presentation, we report a rare case of TTP occurring after a hump-nosed viper bite, with the outcome of the report focusing on the diagnostic difficulties and available therapeutic modalities.

Language: en

Keywords

acute kidney injury; complications of snake bite; hump-nosed viper; microangiopathic hemolytic anemia (maha); plasmic score; therapeutic plasma exchange (tpe); thrombotic thrombocytopenic purpura