title: Marked Hypofibrinogenemia and Gastrointestinal Bleeding After Copperhead (Agkistrodon contortrix) Envenomation.
abstract: Compared with other crotaline envenomations, copperhead envenomations have historically been reported as having less severe hematologic venom effects and rarely hemorrhage. We report a case of clinically significant gastrointestinal bleeding after a copperhead (Agkistrodon contortrix) envenomation. A 52-year-old woman with a history of systemic lupus erythematosus was bitten on her right medial ankle after which hypofibrinogenemia and hematochezia developed. The symptoms resolved after repeated administration of Crotalidae polyvalent immune Fab (ovine) antivenom. She was discharged without further complications 2 days later. Although copperhead envenomations are classically considered less severe than other crotaline envenomations, this case demonstrates the potential of the venom to produce clinically significant hematologic effects.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (Dr Kopec); Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC (Dr Yen); Division of Emergency Medicine, Duke University Medical Center, Durham, NC (Dr Gerardo). Electronic address: ktkopec@gmail.com.
authors.forename: Kathryn T
authors.initials: KT
authors.lastname: Kopec
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (Dr Kopec); Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC (Dr Yen); Division of Emergency Medicine, Duke University Medical Center, Durham, NC (Dr Gerardo).
authors.forename: May
authors.initials: M
authors.lastname: Yen
authors.affiliation: Department of Emergency Medicine, Greenville Health System, Greenville, SC (Dr Bitner).
authors.forename: Matthew
authors.initials: M
authors.lastname: Bitner
authors.affiliation: Division of Emergency Medicine, Palo Alto VA Medical Center, Palo Alto, CA (Dr Evans).
authors.forename: C Scott
authors.initials: CS
authors.lastname: Evans
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC (Dr Kopec); Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC (Dr Yen); Division of Emergency Medicine, Duke University Medical Center, Durham, NC (Dr Gerardo).
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Gerardo
mesh_terms: D000347:Afibrinogenemia / Q000209:etiology / Q000628:therapy; D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D003435:Crotalid Venoms / Q000506:poisoning*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008875:Middle Aged; D012909:Snake Bites / Q000209:etiology* / Q000628:therapy*
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments
keywords: Agkistrodon contortrix; copperhead; envenomation; gastrointestinal bleeding; hypofibrinogenemia