Citation

Fteiha B, Trotter J. Exp. Clin. Transplant. 2024; 22(5): 399-401.

Copyright

(Copyright © 2024, Bas̜kent University)

DOI

10.6002/ect.2023.0323

PMID

38970285

Abstract

Envenomation of humans by snakes, a global health challenge, is poorly studied in liver transplant recipients. We report a case of rattlesnake envenomation in a 52-year-old female patient who had previously received a liver transplant to treat nonalcoholic steatohepatitis cirrhosis. Despite stable graft function since her transplant, she exhibited elevated liver enzymes on admission, with a mixed hepatocellular and cholestatic pattern. Treatment included CroFab Crotalidae polyvalent immune Fab (ovine) antivenom and close monitoring, with continuation of her standard immunosuppression regimen. Inpatient observation showed reduced swelling and pain but persistently elevated enzymes. Imaging indicated fatty infiltration with patent hepatic vasculature. Her liver enzymes improved spontaneously, and she was discharged after 5 days, with complete normalization of herliver enzyme levels as shown by repeated laboratory test results 1 month later. Our case emphasizes the risk of graftinjury in liver transplant recipients, as well as the need for vigilant monitoring and early antivenom administration. We urge furtherresearch to establish guidelines for optimal care in this unique population.

Language: en

Keywords

Humans; Female; Middle Aged; Animals; Treatment Outcome; *Antivenins/therapeutic use; *Liver Transplantation/adverse effects; *Snake Bites/diagnosis/complications; Crotalid Venoms; Crotalus; Immunoglobulin Fab Fragments/therapeutic use; Immunosuppressive Agents/adverse effects/therapeutic use; Non-alcoholic Fatty Liver Disease/surgery/diagnosis