Russell’s Viper Envenomation Complicated by Venom-Induced Consumption Coagulopathy, Myocardial Infarction, and Ischemic Stroke: A Rare Case Report

Background: Snake envenomation is a major medical emergency in tropical regions. Russell's viper envenomation commonly causes venom-induced consumption coagulopathy (VICC), which may lead to severe systemic complications. Although myocardial infarction or ischemic stroke has been reported individually following snakebite, their simultaneous occurrence in the same patient is exceedingly rare. Case Presentation: A 46-year-old woman presented one hour after a suspected Russell's viper bite with tachycardia, hypoxemia, reduced Glasgow Coma Scale score, and prolonged whole blood clotting time, consistent with VICC. She required endotracheal intubation and mechanical ventilation due to respiratory compromise, with bloody endotracheal secretions noted on suctioning. She presented with AMI during her hospitalisation, which was confirmed by electrocardiographic changes, with an increase in cardiac biomarkers. Later she had left upper limb weakness and a neuro-image showed an acute ischemic stroke. Anti-snake venom therapy, supportive care and a multidisciplinary management was given in time. She recovered with residual focal neurological deficit. Conclusion: The case demonstrates the rare occurrence of simultaneous acute myocardial infarction and ischemic stroke after envenomation by Russell's viper. These life-threatening complications may be due to various factors such as VICC, endothelial injury and venom-induced vascular thrombosis. Timely and multidisciplinary management and close cardiovascular and neurological monitoring are crucial for optimizing patient outcomes, while early recognition is necessary.

Keywords: Snake envenomation, Russell's Viper, Venom-induced consumption coagulopathy, Myocardial infarction; Ischemic stroke.