Venom Induced Toxic Ventriculitis Resulting in Acute Reversible Communicating Internal Hydrocephalus, Acute Pituitary Haemorrhage, Acute Hypopituitarism, Acute Kidney Injury, Septicaemia, Cellulitis and DIC Due to Viper Bite in a Young Farmer: A Case Report

Abstract

A young farmer, tenth standard student, helping his grandfather during holiday, developed anuria after viper bite. Because of headache, non-enhanced CT scan head was done on admission which showed a small pituitary haemorrhage with normal ventricles. Later, he had generalized fits and second non-enhanced CT scan head was repeated which revealed a small pituitary haemorrhage with dilated ventricles. He also had acute kidney injury, septicaemia, cellulitis and DIC. The serum level of TSH, free T3 & free T4 were low; thus, replacement was done. Cerebrospinal fluid study (protein, sugar, cells) including culture was normal. Renal replacement therapy (haemodialysis), platelets transfusion and antibiotics were given. He had torrential polyuria (urine output 12 liter per day) when he recovered from renal failure and it improved dramatically with desmopressin replacement. There was improvement in third non-enhanced CT scan head and fourth one was consistent with normal ventricle and reduction in size of pituitary haemorrhage.