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Black Mamba Death

Venom Versus Antivenom?

Blumenthal, Ryan MBChB (Pret), MMed (MedForens) (Pret), DipForMed (SA), FC for Path (SA), PhD (WITS)*†; Scholtz, Pieter Evelyn Pienaar MBChB (Pret), MMed (Cardiothoracic Surgery); Shuttleworth, Jenna-lee BSc (Micro) (Pret), BSc Hons (MedCriminalistics) (Pret)*†

The American Journal of Forensic Medicine and Pathology: July 13, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PAF.0000000000000496
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We present the case of a male adult who was admitted to an emergency department after having sustained envenomation from a black mamba (Dendroaspis polylepis). According to the available history, a single fang hooked his right index finger, post venom extraction. After administering antivenom in the accident and emergency department, further vials were transfused in the intensive care unit. An urticarial rash was noted, which was thought to be related to the antivenom. The victim remained in a coma for 3 days, after which he was declared dead. A medicolegal postmortem examination was performed 4 days after death because of logistical reasons. The complexities of differentiating acute envenomation from black mamba versus early acute reactions to polyvalent antivenom administration are highlighted in this case study.

From the *Department of Forensic Medicine,

Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Manuscript received April 8, 2019; accepted April 30, 2019.

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.amjforensicmedicine.com).

Reprints: Ryan Blumenthal, MBChB (Pret), MMed (MedForens) (Pret), DipForMed (SA), FC for Path (SA), PhD (WITS), Room 4-44, Pathology Building, 5 Bophelo Road, Prinshof Campus, Riviera, 0084, Pretoria, South Africa. E-mail: ryan.blumenthal@up.ac.za.

© 2019 by Lippincott Williams & Wilkins.