Late emergence of myasthenia gravis complicating envenoming by Viperaammodytes.
Natasha K Simonovska, Aleksandra Babulovska, Kiril Naumoski et al.
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Case in brief
A 41-year-old construction worker experienced a snakebite from Vipera ammodytes, leading to local swelling and visual disturbances. Initial treatment included antivenom and corticosteroids, resulting in temporary improvement. However, he later developed neurological symptoms such as ptosis, diplopia, and muscle weakness. A trial with neostigmine confirmed myasthenic syndrome, and he was treated with pyridostigmine and prednisone. After initial improvement, symptoms recurred, necessitating ongoing management.
What made this case unusual
The late emergence of myasthenia gravis symptoms following snake envenomation is atypical and highlights the need for vigilance in monitoring post-snakebite complications.
Diagnostic / clinical pearl
Clinicians should be aware that neurological symptoms can emerge after snake envenomation, necessitating careful long-term follow-up and reassessment.
Why it matters
This case underscores the importance of recognizing and managing delayed complications of snakebite envenomation, which may not be immediately apparent during acute treatment.