Venom-Induced Consumption Coagulopathy, Disseminated Intravascular Coagulation, and Compartment Syndrome Following Red-Tailed Green Pit Viper/ Lesser Sunda Pit Viper Envenomation in Timor-Leste: A Two-Case Report

Snake envenomation, particularly in Southeast Asia, often results in venom-induced consumption coagulopathy (VICC), a life-threatening condition characterized by severe bleeding and coagulopathy. Despite its clinical significance, management protocols for VICC remain under-researched, especially in resource-limited settings such as Timor-Leste. Two male adults were bitten in Timor Leste by green snake with reddish tail. A 47 years old male was bitten by a green snake with reddish tail from municipality and presented with severe symptoms, including epistaxis, conjunctival bleeding, hematemesis, melena, hemoptysis, hematuria, compartment syndrome at bite site and immediate black out at the location before he was taken to referral hospital in Maliana municipality and referral immediately to our setting at hospital national Guido Valadares in Dili Timor-Leste. The second was a male 73 years old bitten by green snake with reddish tail at nearby Dili and presented with severe symptom of gums bleeding, nausea and hematemesis but kept at home for two days with the trial of traditional healer than presented to emergency department with uncontrolled bleeding and decrease level of consciousness. For both cases the diagnosis was made based on clinical and history of green snake bite because there was no confirmed with a 20 min whole blood clotting test as this practice is no routinely done in Timor-Leste setting.
Initial treatment involved transfusion of Packed red cells (PRC) transfusion, Intravenous Steroids, Intravenous tranexamic acid to stop bleeding, anticoagulant agent Vitamin K and broad-spectrum intravenous antibiotics to cover infection as per local guidelines. In local setting, do not have antivenom available for green snake bites. VICC management in local setting is challenging. The initial administration of anti-snake venom (ASV) is the key treatment to neutralize procoagulant toxins, but in the absence of ASV, the administration of blood transfusion such as packed red blood cells (PRCs) and Platelets (PC) can be utilized to manage coagulopathy and as supportive measures based on patient’s clinical findings. The timing and combination of these treatments are crucial in optimizing the results. Proper diagnosis of VICC involves a thorough clinical assessment and diagnostic testing. Management of VICC requires prompt administration of ASV and management tailored to the patient’s condition and available resources. These cases report aim to examine the management strategies of VICC, specifically the role of blood component transfusion, and highlight the challenges of treatment in resource-limited settings in the countries where ASV is always not available.

ASV: Anti Snake venom, VICC: venom-induced consumption coagulopathy, DIC: disseminated intravascular coagulopathy, CS: compartment syndrome

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