Envenoming by Viridovipera stejnegeri snake: A patient with liver cirrhosis presenting disruption of hemostatic balance

Background: in most cases of envenoming by the green habu viridovipera stejnegeri in taiwan coagulopathy is not observed. case presentation: herein,we describe the case of a patient with liver cirrhosis who developed venom-induced consumptive coagulopathy after v. stejnegeri bite. laboratory investigation revealed the following: prothrombin time > 100 s (international normalized ratio > 10),activated partial thromboplastin time > 100 s,fibrinogen < 50 mg/dl,and fibrin degradation product > 80 μg/ml. the patient recovered after administration of bivalent hemorrhagic antivenom,vitamin k,fresh frozen plasma and cryoprecipitate. conclusion: the liver,directly involved in the acute phase reaction,is the main responsible for neutralization of animal toxins. any patient with history of liver cirrhosis bitten by a venomous snake,even those whose venoms present low risk of coagulopathy,should be very carefully monitored for venom-induced consumptive coagulopathy (vicc),since the hemostatic balance may be disrupted. © 2017 the author(s).