Horned-Viper Bite: A Clinical Case and Review of Therapeutic Approach
DOI:
https://doi.org/10.20344/amp.24300Keywords:
Antivenins, Disseminated Intravascular Coagulation, Hyperbaric Oxygenation, Snake BitesAbstract
Envenomation by the horned viper (Vipera latastei), endemic to the Iberian Peninsula, typically causes local and hematologic toxicity, potentially leading to venom-induced consumption coagulopathy. We report the case of a 39-year-old man bitten on the fourth finger of his left hand. The first dose of antivenom (ViperFav®) was administered 10 hours after the incident, followed by two additional doses due to persistent coagulopathy and transient thrombocytopenia. Hyperbaric oxygen therapy (10 sessions) and a transdermal nitroglycerin patch were used to optimize local perfusion as adjuvant therapies that are still discussed in the medical literature. Clinical evolution was favorable, with preservation of finger viability and progressive laboratory recovery. This case highlights the importance of early antivenom administration, continuous hematologic monitoring, and the potential benefits of integrating adjuvant therapies to prevent necrosis and systemic complications. A multidisciplinary approach enabled full functional recovery without sequelae.
Downloads
References
Valdoleiros SR, Gonçalves I, Silva C, Guerreiro D, Silva L, Martinez-Freiria F, et al. Animais venenosos em território português. Acta Med Port. 2021;34:784-95. DOI: https://doi.org/10.20344/amp.15589
Centro de Informação Antivenenos. Dados estatísticos de 2024. Lisboa: INEM; 2024.
Seifert SA, Armitage J, Sanchez E. Snake envenomation. N Engl J Med. 2022;386:68-78. DOI: https://doi.org/10.1056/NEJMra2105228
Maduwage K, Isbister GK. Current treatment for venom-induced consumption coagulopathy resulting from snakebite. PLoS Negl Trop Dis. 2014;8:e3220. DOI: https://doi.org/10.1371/journal.pntd.0003220
World Health Organization. Guidelines for the management of snakebites. 2nd ed. New Delhi: WHO; 2016.
Warrell DA. Venomous bites, stings, and poisoning: an update. Infect Dis Clin North Am. 2019;33:17-38. DOI: https://doi.org/10.1016/j.idc.2018.10.001
Boyer LV, Seifert SA, Clark R, McNally J, Williams S, Nordt S, et al. Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med. 1999;159:706-10. DOI: https://doi.org/10.1001/archinte.159.7.706
Cañas CA. Is the acute compartment syndrome diagnosed in snake bites true?: A review. Medicine. 2024;103:e40008. DOI: https://doi.org/10.1097/MD.0000000000040008
Stewart RM, Page CP, Schwesinger WH, McCarter R, Martinez J, Aust J. Antivenin and fasciotomy/debridement in the treatment of the severe rattlesnake bite. Am J Surg. 1989;158:543-7. DOI: https://doi.org/10.1016/0002-9610(89)90188-8
Garfin SR, Castilonia RR, Mubarak S, HArgens W, Akeson W, Russel F. Role of surgical decompression in treatment of rattlesnake bites. Surg Forum. 1979;30:502.
Hall EL. Role of surgical intervention in the management of crotaline snake envenomation. Ann Emerg Med. 2001;37:175-80. DOI: https://doi.org/10.1067/mem.2001.113373
Korambavil N, Ambookan P, Abrahan S, Ambalakat A. A multidisciplinary approach with hyperbaric oxygen therapy improves outcome in snake bite injuries. Toxicol Int. 2015;22:104. DOI: https://doi.org/10.4103/0971-6580.172287
Hochedez P, Mehdaouni L. Hyperbaric oxygen therapy after Bothrops lanceolatus snake bites in Martinique: a brief report. Undersea Hyperb Med. 2010;37:399-403.
Ince B, Gundeslioglu N. Management of viper bites on the hand. J Hand Surg Eur Vol. 2014;39:642-6. DOI: https://doi.org/10.1177/1753193413496943
DeVito R, Stranix J. Is nitropaste effective in stressed flaps? Ann Plast Surg. 2023;90:S356-8. DOI: https://doi.org/10.1097/SAP.0000000000003339
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Acta Médica Portuguesa

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.

