BACKGROUND Hump-nosed viper bite, the commonest venomous snake bite in Sri Lanka, is associated with significant morbidity. Specific anti-venom is not available for hump-nosed viper envenomation which is usually managed with supportive treatment. Pulmonary haemorrhage is an unusual manifestation of hump-nosed viper bite. Here we present a case of hump-nosed viper envenomation which complicated by pulmonary haemorrhage and was successfully treated with systemic steroids. To the best of our knowledge, it has not been reported in the literature before. CASE PRESENTATION A previously healthy 55-year-old man presented to the local hospital 18 h after a hump-nosed viper bite. He developed bilateral severe pulmonary haemorrhages, evidenced by rapid desaturation which needed intubation and mechanical ventilation, bleeding from the endotracheal tube and bilateral alveolar shadows in a chest x-ray. He had no other bleeding manifestations. Because of the life-threatening situation, he was treated with methylprednisolone pulse therapy. There was a rapid improvement of hypoxia with a resolution of x-ray changes. He was successfully weaned off from the ventilation after 24 h. CONCLUSION This case highlights the importance of suspecting pulmonary haemorrhage in a patient who develops desaturation and alveolar shadow following hump-nosed viper bite even in the absence of other bleeding manifestation. Early and timely treatment with systemic steroid can be lifesaving in such patients.

中文翻译：

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驼背vi蛇咬伤后由于肺出血引起的危及生命的并发症。

背景技术驼峰H蛇咬伤（斯里兰卡最常见的毒蛇咬伤）与高发病率有关。驼峰vi蛇毒化术无法使用特定的抗蛇毒，通常通过辅助治疗来解决。肺出血是驼峰vi蛇叮咬的不寻常表现。在这里，我们介绍一例隆鼻的vi蛇毒化，并发肺出血并已成功应用全身性类固醇治疗。据我们所知，以前没有文献报道过它。病例介绍之前有一个健康的55岁男子在被驼背的毒蛇咬伤18小时后到当地医院就诊。他发展为双侧严重的肺出血，表现为快速脱饱和，需要插管和机械通气，气管导管出血和胸部X光检查中双侧肺泡阴影。他没有其他出血表现。由于危及生命的状况，他接受了甲基强的松龙脉搏疗法的治疗。随着X射线变化的解决，缺氧迅速改善。24小时后，他成功地从通风中断奶了。结论该病例凸显了怀疑即使在没有其他出血表现的情况下，在驼峰状vi蛇咬伤后出现去饱和和肺泡阴影的患者中怀疑肺出血的重要性。在这类患者中，早期及及时应用全身性类固醇治疗可以挽救生命。随着X射线变化的解决，缺氧迅速改善。24小时后，他成功地从通风中断奶了。结论该病例凸显了在没有其他出血表现的情况下，怀疑驼峰vi蛇咬伤后出现去饱和和肺泡阴影的患者怀疑肺出血的重要性。在这类患者中，早期及及时应用全身性类固醇治疗可以挽救生命。随着X射线变化的解决，缺氧迅速改善。24小时后，他成功地从通风中断奶了。结论该病例凸显了怀疑即使在没有其他出血表现的情况下，在驼峰状bit蛇咬伤后出现去饱和和肺泡阴影的患者中，怀疑肺出血的重要性。在这类患者中，早期及及时应用全身性类固醇治疗可以挽救生命。