Severe coagulopathy following snakebite envenomation and challenges in management: a report of two pediatric cases.

Snakebite envenomation (SBE) remains a major neglected tropical disease in sub-Saharan Africa, with West Africa accounting for a substantial proportion of global cases. In Benin, the true impact of SBE is underestimated due to limited epidemiological surveillance, delayed healthcare access, and limited availability of adequate urgent care. We report two fatal pediatric cases of severe Viperidae snakebite envenomation in children aged three and twelve years old managed at a rural hospital in Benin. Both patients died during hospitalization after developing severe coagulopathy despite antivenom therapy, blood transfusions, and supportive care. These cases illustrate the severity of hemorrhagic complications associated with SBE and, most importantly, highlight key contributors to poor clinical outcomes in low-resource settings. Diagnostic uncertainty and resource constraints further complicate the management of suspected complications such as compartment syndrome and intracranial bleeding. SBE remains a critical yet underrecognized cause of pediatric mortality in rural Benin. It would be essential to strengthen public health policies, improve access to effective antivenoms, and implement context-adapted management strategies to reduce SBE-related mortality in sub-Saharan Africa.