Pulmonary Haemorrhage due to Hump-Nosed Viper Bite: Excellent Response to Methyl Prednisolone-Case Report and Review of Literature

Background: Hump-nosed viper bite, the commonest venomous snake bite in Sri Lanka, is associated withsignificant morbidity. Specific anti-venom is not available for hump-nosed viper envenomation which is usuallymanaged with supportive treatment. Pulmonary hemorrhage is an unusual manifestation of hump-nosed viper bite.Here we present a case of hump-nosed viper envenomation which complicated by pulmonary hemorrhage and wassuccessfully treated with systemic steroids. To the best of our knowledge, it has not been reported in the literaturebefore.Case Presentation:A previously healthy 55-year-old man presented to the local hospital 18 hours after a hump-nosed viper bite. He developed bilateral severe pulmonary hemorrhages, evidenced by rapid desaturation whichneeded intubation and mechanical ventilation, bleeding from the endotracheal tube and bilateral alveolar shadows ina chest X-ray. He had no other bleeding manifestations. Because of the life-threatening situation, he was treatedwith methylprednisolone pulse therapy. There was a rapid improvement of hypoxia with a resolution of X-raychanges. He was successfully weaned off from the ventilation after 24 hours.Conclusion:This case highlights the importance of suspecting pulmonary hemorrhage in a patient who developsdesaturation and alveolar shadow following hump-nosed viper bite even in the absence of other bleedingmanifestation. Early and timely treatment with systemic steroid can be lifesaving in such patients.