Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

The hump-nosed vipers which compromise ‘Hypnale hypnale’, ‘H. zara’ and ‘H. nepa’ have been highly venomous snakes and ‘H. zara’ and ‘H. nepa’ are indigenous to Sri Lanka and ‘H. hypnale’ is endemic to Sri Lanka and India. The clinical presentations range from local swelling, blistering and necrosis at the site of bite with distinct fang marks to systemic envenomations such as coagulopathy, thrombotic microangiopathy, acute kidney injury and death in severe cases. Here, we report a case of thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ bite.