Mortality following snake bite envenomation by Bitis arietans in an HIV positive child

Snake bites occur commonly in the rural areas of South Africa. Hospitals where snake bites are uncommon should always have protocols on standby in the event of such cases presenting. This is the first reported case documenting the effect of human immunodeficiency virus (HIV) on snake bite in South African children. A case report and review of relevant information about the case was undertaken. We present a case of a 1-year-old child referred from a peripheral hospital following a snake bite to the left upper limb with a compartment syndrome and features of cytotoxic envenomation. The patient presented late with a wide area of necrotic skin on the arm requiring extensive debridement. The underlying muscle was not necrotic. Polyvalent antivenom (South African Institute of Medical Research Polyvalent Snakebite Antiserum) administration was delayed by 4 days after the snake bite. The patient was also diagnosed with HIV and a persistent thrombocytopenia possibly due to both HIV infection and the snake bite venom. Lower respiratory tract infections with subsequent overwhelming sepsis ultimately resulted in the child's death. The case highlights the challenge of treating a snake bite in a young child with HIV and the detrimental outcome of delayed treatment. A protocol is essential in the management of snake bites in all hospitals. Level IV, Case report. This case highlights the interaction of snake bite envenomation and HIV infection on thrombocytopenia.