Toxin-induced coagulopathy following a MacMahon viper bite

The management of a snakebite is often challenging due to limited experience, limited access to intensive care, delays in presentation and high variability in venom composition and specific antivenom availability. Classified within the genus Eristicophis , the MacMahon viper is a venomous snake species for which only two detailed case reports exist. Its venom has predominantly haemotoxic properties while neurotoxic and cytotoxic effects are less pronounced. This case illustrates the effects of Eristicophis macmahonii venom on both haemostasis and cardiovascular stability, in addition to a significant local envenomation reaction that required intervention. Laboratory analysis revealed a rapid onset of thrombocytopenia and impaired haemostatic function expressed in rotational thromboelastometry (ROTEM) analysis. The first 6 hours represented an acute phase with significant hypotension and associated syncope. In the absence of clinical signs of bleeding, transfusion of blood products or administration of coagulation factors was not initiated. Thrombocytopenia resolved spontaneously within 8 days.