Female, 14 years old.
During a summer camp next to his family, in the locality of the Quisco Region, he picked up a ball under bushes.
At that moment she felt that something squeezed her left hand.
When removing a large, pinched armpit from the back of the hand between thumb and forefinger.
She took her head from behind, with her free hand, and within a few seconds the reptile loosened her hand, and rolled round her left arm.
In order to avoid having to stick to the arch, the parents killed it in a container.
The flapper measured 137 cm in length and its tail was 35 cm. In the dorsal area, it had a dark fringe at the center flanked by clear lateral fringes.
It was not possible to find posterior innocuous teeth.
The bite did not cause pain at the time of the accident and the inoculation site could not be appreciated.
Approximately 30 minutes later, he developed severe pain and swelling at the site of the bite.
The patient was taken to the emergency service of the hospital Carlos van Buren, Valparaíso, Region.
In the initial evaluation it was found a circumferential edema covering up to the union of the lower middle third of the arm, with a punctiform wound in the left hand and erosion of the neighboring zone, cold fingers of the affected limb.
She was hospitalized with a diagnosis of snakebites and observation of a mental disorder syndrome.
Corticosteroids and intravenous antihistamines, NSAIDs and parenteral ampicillin were indicated as treatment.
Local measures indicated were upper arm and ice application.
Of the laboratory tests requested, the following stood out: prothrombinemia: 57% (VN= 70-100%), TTPK: 41 sec (VN= 26-36 sec), platelet count: 150,000 hemoglobin - 14dL.
No leukocyte count was requested.
He was admitted in regular general conditions for the first 24 hours, without fever, but with intense pain in the left upper limb.
The edema extended to the shoulder and pectoral region and the fingers had an ecchymotic appearance.
Pain upon palpation of the affected area and the carotid consistency of the edema stood out.
He had severe headache, nausea and fever, with no evidence of bleeding.
Urine was evaluated daily by color or naked eye to detect hemoglobinuria.
Treatment was maintained with intravenous analgesics and corti-costeroids and edema of the forearm and arm began to decrease.
At 48 hours of evolution there were bullae persistence of the fold of the right elbow, headache decreased, nausea and fever disappeared, with pain in the extremity.
The mobility of the fingers and wrist was limited, but with normal arterial pulse palpation.
Surgeons ruled out mental illness.
At 72 hours of evolution, both edema and pain were in frank regression and corticosteroids and antihistamines were suspended.
On the fourth day of evolution she was discharged, almost without discomfort, with indication to complete predni-sone treatment for two days and antimicrobial treatment for six days.
