Larréché S. auteur aut IRD Le Roux G. auteur aut IRD Chippaux Jean-Philippe auteur aut IRD Hardy J. auteur aut IRD Fédou A. L. auteur aut IRD Labadie M. auteur aut IRD text journalArticle eng text/pdf reformatted digital access Background: Atheris spp. are small African vipers whose bites are rarely reported but can result in significant envenoming. There is no specific antivenom available. We describe a case of systemic A. chlorechis envenoming presenting with venom-induced consumption coagulopathy (VICC), snakebite-associated thrombotic microangiopathy (TMA), and local necrosis. Case presentation: A 33-year-old man was bitten on the index finger by a captive A. chlorechis. Within 6 hours, early laboratory abnormalities progressed to VICC with markedly prolonged PT/aPTT, undetectable fibrinogen, elevated fibrin monomers, and factor V deficiency. Despite the administration of four vials of InoserpTM PanAfrica and repeated transfusions of fibrinogen and fresh frozen plasma, the patient continued to exhibit signs of coagulopathy for 48 hours. Thrombocytopenia, anaemia, schistocytes, and hyperbilirubinemia indicated snakebite-associated TMA, which resolved spontaneously without renal involvement. Progressive local necrosis developed on the finger and dorsal hand, ultimately requiring amputation of the proximal phalanx and surgical debridement. Conclusion: This case demonstrates that A. chlorechis envenoming can produce both local and systemic toxicity. The absence of clinical improvement after InoserpTM Pan-Africa is consistent with preclinical data showing limited cross-neutralization against Atheris venoms. Administration of clotting factors in the presence of unneutralized procoagulant toxins may have contributed to the development of TMA. Therefore, 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. The local necrosis highlights the potential for significant local sequelae, necessitating cautious but timely surgical intervention. specialized Venom-induced consumption coagulopathy Snakebite-associated thrombotic microangiopathy Fresh frozen plasma Local cytotoxicity Amputation Antivenom FRANCE 050 080 274 109021 [8 ] 2026 0041-0101 https://www.documentation.ird.fr/hor/fdi:010096384 10.1016/j.toxicon.2026.109021 0041-0101 [F B010096384] https://www.documentation.ird.fr/hor/fdi:010096384 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2026-03/010096384.pdf IRD - Base Horizon / Pleins textes 2026-03-11 2026-03-24 fdi:010096384 fre