Management of a chronic non-healing viper bite ulcer in a patient with alcoholic liver cirrhosis: A Case Report

Abstract

Snake bite complication often lead to tissue necrosis, cellulitis, non-healing ulcers and systemic disturbance such as coagulopathy and ascites, making management highly challenging. A 50-year-old male presented with chronic non-healing ulcer on the right limb that persisted for 58 days despite conventional treatment and was associated with severe pain, foul odour and deep tissue involvement including subcutaneous tissue and facia, bone and muscle were not exposed. The ulcer measured 11.5 cm in length, 6.2 cm in width and 5 mm in depth with necrotic fascia involvement. The patient also had decompensated liver cirrhosis, characteristic by ascites (abdominal girth 95 cm), pitting oedema, oliguria, urinary dribbling, low serum albumin (3.4 g/dL) and elevated total bilirubin (2.7 mg/dL). Therefore, the overall prognosis remains poor owing to advanced hepatic decompensation with associated hepatorenal involvement and necrotic fascio-muscular changes, indicating multi-organ dysfunction and markedly reduced physiological reserve. Ayurveda management was initiated with vardhamana pippali followed by virechana, along with supportive therapies including vrana prakshalana, vrana ropana and jalaukavacharana. Management based on vrana and yakritodara chikitsa improved ulcer healing, liver function and ascites, leading to a better clinical outcome despite a poor prognosis. Over two months, there was progressive ulcer healing with a reduction in ulcer size to 4.5 cm in length, 2 cm in width and 2mm in depth, complete resolution of oedema, 29 cm decrease in abdominal girth, improved liver function (serum albumin – 4.1 g/dL, total bilirubin 0.8 mg/dL) and relief in urinary complaints. Subsequently, complete healing was achieved after 10 months, with no recurrence of the ulcer and ascites observed during the follow-up period. The Child-Pugh score improved from Grade C to Grade A. This case highlights the potential role of Ayurveda interventions in chronic non-healing ulcers with systemic complications.