Fatal Bothrops atrox snakebite with thrombotic microangiopathy, hemorrhagic stroke and acute kidney injury

Bothrops atrox is responsible for most snakebite envenomations in the Amazon region. Its venom induces systemic hemostatic disturbances and local tissue damage, potentially leading to severe complications. This report describes a fatal case of B. atrox envenomation in a 53-year-old male with a history of hypertension and alcoholism. The patient presented with persistent incoagulable blood, thrombocytopenia, anemia, and progressive renal dysfunction. These findings were consistent with venom-induced consumption coagulopathy (VICC) associated with thrombotic microangiopathy (TMA). He subsequently developed intracranial hemorrhage, the autopsy revealed a confirmed subarachnoid hemorrhage, and acute kidney injury (AKI), which contributed to systemic decompensation. Postmortem findings included subarachnoid hemorrhage, acute tubular necrosis, hepatic steatosis, and fibrin thrombi in cutaneous vessels. This case highlights the potential for severe systemic involvement in Bothrops atrox envenomation, particularly in patients with preexisting comorbidities, and underscores the need for early recognition of complications such as VICC and TMA to guide appropriate clinical management.