Sochureki, the different saw- scaled viper: Challenges are many!

Snake bite is a major cause of mortality in the Indian subcontinent. The condition is fraught with the problem of under reporting. Most bites in India are caused by the "Big 4 species," based on this, the anti-snake venom (ASV) is also sourced from these species only. It has been observed that the venom of snakes from different regions respond differently to it, as is sourced mainly from snakes of southern region of India. We present a case of a saw-scaled viper (SSV) bite, where the patient had unusual presentation of thrombotic microangiopathy (TMA) along with venom-induced consumption coagulopathy (VICC). The patient was resistant to ASV and finally succumbed. The snake was identified as Echis carinatus sochureki (a subspecies of SSV). This case highlights that VICC is the commonest presentation in a SSV bite, rather than disseminated intravascular coagulation (DIC). The organ failure in such bites is due to rare coexistence of TMA (especially in an E carinatus sochureki bite) and should not be attributed to DIC. It also identifies that the polyvalent ASV produced in India is not effective against E carinatus sochureki bite.