title: First reported case of systemic envenoming by the Sri Lankan keelback (Balanophis ceylonensis).
abstract: Envenoming by colubrid snakes is rarely reported. However, some colubrid snakes (e.g. Rhabdophis tigrinus and Rhabdophis subminiatus) have caused severe systemic envenoming. We report here the first case of a bite with systemic envenoming by Balanophis ceylonensis, an opisthoglyphous natricine colubrid, in Sri Lanka. A 33-year-old healthy male field biologist was bitten while handling the snake for photography. Within 5 min of the bite on the dorsum of the right hand, he reported severe occipital headache, photophobia, chills and transient loss of consciousness. He vomited blood-stained gastric contents and bled from venepuncture sites. He had a markedly elevated INR and positive D-dimer test suggestive of significant coagulopathy that was treated with infusions of fresh frozen plasma. He recovered and left hospital after 96 h and subsequent investigations, including electroencephalogram, were normal. We conclude that B. ceylonensis should be regarded as a medically significant venomous snake. This case highlights the need for further studies of the oral secretions (venoms) of colubrid snakes.
authors.affiliation: Base Hospital, Elpitiya, Sri Lanka.
authors.forename: W K B K M
authors.initials: WK
authors.lastname: Fernando
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka. Electronic address: samkul@sltnet.lk.
authors.forename: S A M
authors.initials: SA
authors.lastname: Kularatne
authors.affiliation: Base Hospital, Elpitiya, Sri Lanka.
authors.forename: S P K
authors.initials: SP
authors.lastname: Wathudura
authors.affiliation: 15/1 Dolosbage Road, Gampola, Sri Lanka.
authors.forename: A
authors.initials: A
authors.lastname: de Silva
authors.affiliation: Department of Zoology, Graduate School of Science, Kyoto University, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Mori
authors.affiliation: Department of Zoology, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
authors.forename: D
authors.initials: D
authors.lastname: Mahaulpatha
mesh_terms: D000328:Adult; D000818:Animals; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000473:pathology*; D017812:Colubridae; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006261:Headache / Q000209:etiology / Q000473:pathology*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D020795:Photophobia / Q000209:etiology / Q000473:pathology*; D012909:Snake Bites / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D013188:Sri Lanka / Q000453:epidemiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Balanophis ceylonensis; Coagulopathy; Colubrid; Headache; Snake; Sri Lankan keelback