Background
Snakebite envenoming is a significant uncared for tropical illness, significantly in rural areas of tropical and subtropical international locations. Echis carinatus (saw-scaled viper; SSV), prevalent within the desert areas of Iran, is a medically vital species of the Viperidae household whose venom disrupts hemostasis by way of potent procoagulant exercise. Whereas venom-induced consumption coagulopathy (VICC) is nicely acknowledged as a hemorrhagic complication, thrombotic sequelae are uncommon and poorly documented.
Case presentation
We report the case of a 15-year-old male who offered to the emergency division shortly after a SSV chew to the ankle. Preliminary manifestations included native swelling, gentle bleeding, and dizziness. He was promptly handled with intravenous polyvalent antivenom, tetanus toxoid vaccination, and supportive remedy. Baseline investigations revealed coagulopathy, which normalized with remedy; nonetheless, serial follow-up demonstrated progressive cytopenias. At roughly three months post-envenomation, the affected person developed belly ache. Imaging revealed aneurysmal dilatation of the portal vein, intrahepatic portal vein thrombosis (PVT), vascular collaterals, and splenomegaly. Endoscopic analysis confirmed secondary esophageal varices in step with portal hypertension. The affected person underwent a number of classes of endoscopic band ligation and was managed with apixaban, propranolol, and proton pump inhibition. Regardless of remedy, persistent splenomegaly and thrombocytopenia had been noticed. Evaluate of obtainable laboratory knowledge means that the thrombotic course of started throughout the first month following envenomation; nonetheless, resulting from delayed referral and restricted entry to specialised care, analysis and remedy had been initiated after the thrombus had already produced irreversible sequelae.
Conclusions
This case demonstrates a uncommon however critical thrombotic complication of SSV envenomation, mediated by a rebound hypercoagulable part following VICC, progressing to PVT, portal hypertension, splenomegaly, and esophageal varices. Whereas acute administration of snakebite focuses on antivenom and supportive measures, this report highlights the significance of long-term surveillance to detect delayed vascular problems. Moreover, it underscores how diagnostic and therapeutic delays can permit thrombotic processes to evolve into power, irreversible outcomes. Clinicians in endemic areas ought to keep vigilance for each hemorrhagic and thrombotic manifestations of Echis carinatus envenoming.
Amirbeigy, M.Ok., Vahedian-Ardakani, H., Shahbaz, A.P.A. et al. Portal vein thrombosis as a scientific dilemma in Echis carinatus envenomation: a case report and evaluate of the literature. Thrombosis J 24, 15 (2026). https://doi.org/10.1186/s12959-026-00827-y
