Potentially fatal coagulopathy secondary to yamakagashi (Rhabdophis tigrinus) bites that completely recovered with antivenom treatment.

CASE: A healthy 40-year-old man was admitted with severe coagulopathy that developed after Rhabdophis tigrinus bites. On admission, he showed significantly elevated levels of thrombin-antithrombin III complex (60 ng/mL), plasmin-alpha 2-plasmin inhibitor complex (22.3 μg/mL), and fibrinogen degradation products (592 μg/mL). He subsequently developed severe hypofibrinogenemia (50 mg/dL).

OUTCOME: Antivenom was given 28 h after the patient was bitten, following which his hemorrhagic symptoms resolved. By day 3 of admission, scabs had formed over the bite wounds. Furthermore, his fibrinogen levels increased to >100 mg/dL, while his thrombin-antithrombin III complex, plasmin-alpha 2-plasmin inhibitor complex, and fibrinogen degradation product levels normalized. He was discharged on day 6 of admission.

CONCLUSION

Rhabdophis tigrinus bites induced disseminated intravascular coagulation with a fibrinolytic phenotype, which completely recovered with antivenom treatment.