Envenomation by a Razi's viper, Macrovipera razii (Serpentes: Viperidae) in Iran: A neglected public health threat, report of two cases, and clinical implications.
Seyed Mahdi Kazemi, Fatemeh Salabi
✦ AI-curated · Sources linked
Case in brief
Two men in Iran developed severe local injury after bites from Macrovipera razii. A 36-year-old man bitten on a finger received six vials of polyvalent antivenom but developed progressive necrosis, leaving permanent deformity and severe functional impairment. A 37-year-old man bitten on the hand received eight vials during initial treatment; progressive edema raised concern for acute compartment syndrome, prompting emergency fasciotomy. After delayed wound closure and prolonged hospitalization, he had persistent partial functional impairment. The cases document substantial local morbidity, but cannot establish the typical course of envenomation or whether antivenom was effective.
What made this case unusual
Both cases involved severe, progressive local tissue injury despite administration of polyvalent antivenom; one required fasciotomy for suspected acute compartment syndrome. The authors caution that these clinical observations alone cannot establish antivenom failure.
Diagnostic / clinical pearl
Severe progressive swelling after M. razii envenomation may raise concern for acute compartment syndrome and require urgent assessment; clinical outcomes alone do not establish antivenom efficacy or failure.
Why it matters
The limited clinical record and absence of venom–antivenom cross-reactivity and functional neutralization data leave antivenom coverage uncertain, supporting further clinical and experimental investigation.