Case presentation
This study was conducted according to the
declaration
of Helsinki principles. Also, guidelines and methodology have been
followed in this study. A 65-year-old man referred to the Cardiovascular
Center following chest pain with dissemination to the left upper
extremity, cold sweats, chills, his had nausea and vomiting, and edema
in the left upper extremity. At the time of entering the Cardiovascular
Center, the patient had no fever and blood pressure was 113/68mmHg,
pulse rate was 76beat/min and respiratory rate was 20 breaths/min. In
examination, the ECG had a normal sinus rhythm and showed no changes
indicative myocardial infarction. Blood samples were also taken to test
for cardiac enzymes, Troponin˂0.2 and BUN = 46 mg/dL and Creatinine =
2.5 mg/dL. After 6 hours, the swelling of the left upper limb progressed
and multiple blisters appeared, after which the patient was referred to
an infectious center in the northern Iran for examination for infection,
necrotizing fasciitis and compartment syndrome. After admission to the
infectious center, the patient had a fever (T = 38.5) and tachycardia
(PR = 108/min) with decreased level of consciousness. In the emergency
room of the infectious center, first the patient’s airway checked out
and to monitor his vital signs, cardiac monitoring and pulse oximetry
along with oxygen therapy with O2 mask were performed.
Blood pressure and respiratory rate were within normal limits, and
examination of the lungs, abdomen, and central nervous system showed no
abnormal findings. On examination of the left upper limb; there was
erythema, warmness, stiffness, non-pitting edema, and limitation of
active movement. Also, vesiculobullous lesions were seen on the dorsal
surface of the hand to the wrist and both flexor and extensor surfaces
of the forearm and arm up to the proximal arm and left axillary area.
(figure 1-A, B)
The location and size of the axillary lymph nodes were normal and the
left radial pulse was weakly palpable. Also Swelling, redness, and
localized infection were seen in the distal third finger of the left
hand, and according to the patient’s history of burning sensation in the
same finger after lifting a heavy object at home 3 days ago and also the
endemicity of his place of habitation raised the probability of a
venomous snake bite, and for this reason the patient was transferred to
the poisoning ward.
The patient had no history of smoking or drug usage, his had a history
of dyslipidemia, hypertension, diabetes mellitus and ischemic heart
disease, which had been controlled with appropriate medications and was
asymptomatic in routine life.
He also had no history of asthma, allergies, rhinitis, dermatitis or
eczema and did not have a history of similar bites in the past.