Envenoming after a snakebite from the Northeast African saw-scaled viper Echis pyramidum: prolonged therapy upon failed treatment by antivenom.

A reptile holder based in the Czech Republic was bitten into his hand and foot by the Northeast saw-scaled viper (Echis pyramidum). The person arrived at the health institution after twenty hours for anuria. Despite the antivenom against the Asian Echis carinatum - the Echis pyramidum's close relative - was readily available and administered repeatedly, the envenoming continued to develop with subsequent coagulopathy, hepatopathy and respiratory failure. The effects of plasmapheresis and symptomatic therapy were positive, but only temporary. Continual renal replacement therapy and plasmapheresis were complicated by thrombotic occlusions of the device tubing set. A turning point arrived following repeated application of imported antivenom containing antigens against venom components of another African saw-scaled viper species, Echis leucogaster (the antivenom containing E. pyramidum antigens was not available). The clinical status, including complications, resolved following 30 days of hospitalization. The case further validates the geographical specifics of immunogenicity of venom components with similar clinical action in snakes of the same genus.