@article{fdi:010096384,
  title = {{S}evere venom-induced consumption coagulopathy, snakebite-associated thrombotic microangiopathy, and local necrosis following {W}estern bush viper ({A}theris chlorechis) envenoming in {F}rance},
  author = {{L}arr{\'e}ch{\'e}, {S}. and {L}e {R}oux, {G}. and {C}hippaux, {J}ean-{P}hilippe and {H}ardy, {J}. and {F}{\'e}dou, {A}. {L}. and {L}abadie, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {A}theris spp. are small {A}frican vipers whose bites are rarely reported but can result in significant envenoming. {T}here is no specific antivenom available. {W}e describe a case of systemic {A}. chlorechis envenoming presenting with venom-induced consumption coagulopathy ({VICC}), snakebite-associated thrombotic microangiopathy ({TMA}), and local necrosis. {C}ase presentation: {A} 33-year-old man was bitten on the index finger by a captive {A}. chlorechis. {W}ithin 6 hours, early laboratory abnormalities progressed to {VICC} with markedly prolonged {PT}/a{PTT}, undetectable fibrinogen, elevated fibrin monomers, and factor {V} deficiency. {D}espite the administration of four vials of {I}noserp{TM} {P}an{A}frica and repeated transfusions of fibrinogen and fresh frozen plasma, the patient continued to exhibit signs of coagulopathy for 48 hours. {T}hrombocytopenia, anaemia, schistocytes, and hyperbilirubinemia indicated snakebite-associated {TMA}, which resolved spontaneously without renal involvement. {P}rogressive local necrosis developed on the finger and dorsal hand, ultimately requiring amputation of the proximal phalanx and surgical debridement. {C}onclusion: {T}his case demonstrates that {A}. chlorechis envenoming can produce both local and systemic toxicity. {T}he absence of clinical improvement after {I}noserp{TM} {P}an-{A}frica is consistent with preclinical data showing limited cross-neutralization against {A}theris venoms. {A}dministration of clotting factors in the presence of unneutralized procoagulant toxins may have contributed to the development of {TMA}. {T}herefore, fresh frozen plasma and fibrinogen should be reserved for cases of coagulopathy with active bleeding or when an invasive procedure is being considered, particulary in the absence of a concomitant effective antivenom. {T}he local necrosis highlights the potential for significant local sequelae, necessitating cautious but timely surgical intervention.},
  keywords = {{V}enom-induced consumption coagulopathy ; {S}nakebite-associated thrombotic ; microangiopathy ; {F}resh frozen plasma ; {L}ocal cytotoxicity ; {A}mputation ; {A}ntivenom ; {FRANCE}},
  booktitle = {},
  journal = {{T}oxicon},
  volume = {274},
  numero = {},
  pages = {109021 [8 p.]},
  ISSN = {0041-0101},
  year = {2026},
  DOI = {10.1016/j.toxicon.2026.109021},
  URL = {https://www.documentation.ird.fr/hor/fdi:010096384},
}