Occult Hemotoxic Envenomation presenting as Fulminant Septic Shock with Disseminated Intravascular Coagulation in a Young Male: A Diagnostic Challenge.

Abstract

We report a case of a previously healthy 17-year male who presented with a sudden onset of fever, severe myalgia, altered sensorium, and rapidly progressive shock. Initial evaluation revealed severe metabolic acidosis, thrombocytopenia, acute kidney injury, and markedly elevated inflammatory markers, raising suspicion for fulminant septic shock with multiorgan dysfunction. Broad-spectrum antimicrobial therapy and intensive supportive care was initiated. Microbiological cultures from blood, urine, and cerebrospinal fluid were sterile. The clinical course was further complicated by early development of purpura fulminans and laboratory evidence of disseminated intravascular coagulopathy. A diagnostic turning point occurred following the incidental identification of two punctate scabbed lesions over the lateral aspect of the foot, suggestive of a possible bite mark. In the context of sterile cultures, abrupt disease progression, and consumptive coagulopathy, occult snake bite with venom-induced consumptive coagulopathy was strongly considered. The patient demonstrated gradual recovery with vasopressor and other organ support in ICU. This case highlights a rare but important diagnostic dilemma in which occult hemotoxic envenomation closely mimicked fulminant septic shock. In endemic regions, snakebite envenomation should be considered in patients presenting with hyperacute shock, coagulopathy, and multiorgan dysfunction, particularly when microbiological evidence of infection is lacking.