Severe venom-induced consumption coagulopathy, snakebite-associated thrombotic microangiopathy, and local necrosis following Western bush viper (Atheris chlorechis) envenoming in France

This case demonstrates that A. chlorechis envenoming can produce both local and systemic toxicity. The absence of clinical improvement after Inoserp™ Pan-Africa is consistent with preclinical data showing limited cross-neutralization against Atheris venoms. Administration of clotting factors in the presence of unneutralized procoagulant toxins may have contributed to the development of TMA. Therefore, fresh frozen plasma and fibrinogen should be reserved for cases of coagulopathy with active bleeding or when an invasive procedure is being considered, particulary in the absence of a concomitant effective antivenom. The local necrosis highlights the potential for significant local sequelae, necessitating cautious but timely surgical intervention.