White-Lipped Tree Viper (Cryptelytrops albolabris) Envenomation in an American Viper Keeper.

BACKGROUND: Snakebites are common in many regions of the United States. Bites from exotic species, however, are rare. The white-lipped tree viper, Cryptelytrops (formerly Trimeresurus) albolabris, is a pit viper native to Southeast Asia. Bites are common in countries such as Myanmar, India, Thailand, Indonesia, and China. In this report, we describe an envenomation in an American viper keeper.

CASE REPORT: A healthy 28-year-old right-handed man who collects venomous snakes experienced a bite to the distal left thumb from a neonatal C. albolabris while feeding it. Upon arrival to the Emergency Department 30 min after the bite, the patient complained of significant pain and swelling that had progressed across his entire hand. He also experienced nausea, lightheadedness, mild dyspnea, and a burning sensation in his lungs. After discussing the risks and benefits, we elected to treat with five vials of Thai Red Cross Green Pit Viper antivenin. The patient was also treated with intravenous fluids, parenteral opioids, and ondansetron. He received an additional five vials due to worsening hematologic laboratory values. His laboratory tests normalized and his local findings improved significantly. He was asymptomatic at discharge and at multiple follow-up visits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Envenomation by C. albolabris is characterized by local tissue injury and hematotoxicity. Supportive care and specific antivenom therapy comprise the management of these bites. This case reminds physicians that not all bites that present to the hospital will be from native snakes and helps direct emergency physicians to specific expertise and uncommon antivenoms.