PP160 A CASE OF DERMONECROSIS DUE TO NAJA KAOUTHIA ENVENOMING: SERIAL PROGRESSION OF WOUND INJURY AND HEALING

Abstract

Introduction:

Peninsular Malaysia has 2 venomous Naja species cobra.  Envenoming by the Naja species may cause paralysis from systemic neurotoxic effect and local envenoming that cause severe pain, local swelling and significant tissue necrosis (dermonecrosis). We presented a case to highlight the serial progression of dermonecrosis following envenoming to guide management of similar cases in the future.

Case report:

An 11 year old Malay boy presented with unidentified animal bite over the left index finger. The patient became drowsy with ptosis and was intubated. He also developed dermonecrosis of the left index finger. He received a total of 15 vials of Naja kouthia antivenom. Day 4 post snake bite, he developed persistant spike of temperature. The bitten index finger showed local tissue swelling and blister formation with erythematous area surrounding the dermonecrosis area. There was a foul smelling aspirate from the blister. Orthopedic team proceeds for wound debridement on day 6 post snake bite. Intraoperative finding revealed 3mls pus at zone 6 extensor. Necrotic tissue debrided and slough tissue removed. Brunner incision made at volar aspect of left index finger. Blister fluid showed Morganella morganii species which was sensitive to Augmentin. Day 3 post wound debridement, the wound at bitten index finger was clean with no pus discharge. Presence of granulation tissue with minimal slough at the edge of debride area. He was discharged home with follow up under wound team for wound healing.

Discussion and Conclusion:

Understanding the stages of wound progression of dermonecrosis due to Naja species envenoming is important in optimizing the treatment plan and to avoid pitfalls in the management