A 37 year old man is brought to the hospital with drowsiness and history of unknown animal bite one hour ago. He was walking through a grassy field during the night when he felt an acute sharp bite on the right foot. He could not see the creature in the dark. This was followed by immediate deep aching pain. On examination, two well defined puncture wounds 10mm were present on the medial aspect of the right leg. Bleeding from the wound was present. The surrounding area had mild swelling and was intensely painful. His blood pressure was 145/90mm hg, and heart rate was 96/min.
Under observation, the patient developed bilateral ptosis, dysphonia, labored breathing and was unable to hold his neck erect. A blister developed at the bite site. Coagulation studies, blood counts and renal function were normal at the emergent situation. What is the likely diagnosis? Source: AminMR et al. J. Venom.…
