Western Bush Viper (Atheris chlorechis) Envenomation: A Case Report.

INTRODUCTION: Western bush viper (Atheris chlorechis) envenomation is rarely encountered worldwide and has been reported only very rarely in the United States (U.S.). Although there is no antivenom (AV) specific to Atheris species, polyvalent AVs are used to treat closely related species. We discuss the case of a 49-year-old female exotic snake breeder in the U.S. who was bitten on her left thumb by a Western bush viper. CASE REPORT: The patient was initially evaluated at a community hospital emergency department before being transported to a tertiary care center for both AV administration and medical toxicologist evaluation. The patient received two vials of exotic polyvalent AV (Inoserp™ PAN-AFRICA) obtained from a nearby regional zoo for worsening cytotoxicity and an additional two vials for thrombocytopenia. Her extremity swelling, pain and laboratory values improved after AV administration, and the patient was discharged on hospital day three in stable condition. DISCUSSION: Envenomations by exotic snakes present challenges in care. If a potentially life-threatening envenomation occurs, clinicians should consult with a regional poison control center and medical toxicologist to facilitate locating both optimal AV and treatment facilities.