Moderate snakebite envenomation complicated by an early adversereaction to antivenom: a case report from the Peruvian Amazon

• Autores: Llamo-Barboza, María de los Ángeles, Flores-Flores, Edward Alexander, Correa-Vega, Justo Fernando, Tuesta-Nole, Juan Rodrigo
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Universidad de San Martín de Porres
• Repositorio: Horizonte médico
• Lenguaje: español; inglés
• OAI Identifier: oai:horizontemedico.usmp.edu.pe:article/3911
• Enlace del recurso: https://horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/3911
• Nivel de acceso: acceso abierto
• Materia: Snake Bites; Snake Venoms; Bothrops; Antivenins; Drug-Related Side Effects and Adverse Reactions; Mordedura de Serpiente; Venenos de Serpiente; Antivenenos; Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos

Snakebite envenomation is a common public health problem in the Peruvian Amazon, where most cases are caused by snakes of the genus Bothrops. The treatment of choice is antivenom; however, both early and late adverse reactions have been reported, although such cases remain scarce in Peru.We report the case of a patient with moderate snakebite envenomation who developed an early allergic reaction (EAR) to antivenom, and describe the clinical and therapeutic management provided. The patient was a 51-year-old female farmer who was bitten on the left thigh by a snake of the genus Bothrops. At Hospital Picota, she received one vial of polyvalent Bothropsantivenom but developed a skin rash and dyspnea, which led to discontinuation of the infusion.She was referred to Hospital II-2 Tarapoto of Ministerio de Salud – MINSA (Ministry of Health), where inflammation and edema were observed involving two-thirds of the thigh. She received antibiotic therapy, analgesics, mannitol, and short-term corticosteroids, and required a transfusion of one unit of packed red blood cells due to severe symptomatic anemia. She showed a favorable recovery after seven days of hospitalization and was discharged.This case underscores the importance of promptly recognizing and managing early reactions to antivenom, including immediate discontinuation of the infusion and supportive treatment, while also considering therapeutic alternatives when antivenom therapy cannot be completed. Recent literature emphasizes avoidingprophylactic antibiotics and reserving their use for documented infections, as well as the need for active monitoring of adverse reactions.Adverse reactions to antivenom pose a therapeutic challenge in the management of snakebite envenomation (ICD-10: T63.0).Clear protocols, staff training, and updated national registries are essential to improving outcomes in endemic regions of Peru.