American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2021, 9(2), 137-139
DOI: 10.12691/ajmcr-9-2-10
Open AccessCase Report

Favorable Course after a Second Infusion of Antivenin Using Premedication

Ikuto Takeuchi1, Kei Jitsuiki1 and Youichi Yanagawa1,

1Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan

Pub. Date: December 20, 2020

Cite this paper:
Ikuto Takeuchi, Kei Jitsuiki and Youichi Yanagawa. Favorable Course after a Second Infusion of Antivenin Using Premedication. American Journal of Medical Case Reports. 2021; 9(2):137-139. doi: 10.12691/ajmcr-9-2-10


An 80-year-old woman had suffered a mamushi bite to the left hand 3 days ago and visited a local hospital. She was admitted for observation but received only tetanus toxoid, antibiotic and cepharanthine. Physicians hesitated to administer antivenin due to the risk of severe side effects, as she had previously received antivenin for mamushi bite at 50 years old. On the third day, the swelling had reached her left chest (grade V), so she was transferred to our hospital via ambulance. She had two bite wounds from a mamushi on her left hand and showed swelling with subcutaneous hemorrhaging from the finger to her chest and upper back. Chest computed tomography showed left pleural effusion. She underwent infusion of mamushi antivenin after premedication using a subcutaneous injection of 0.3 mg of adrenaline and drip infusion of 10 mg of chlorpheniramine, 20 mg of famotidine and 100 mg of hydrocortisone. She was not complicated with an anaphylactic reaction. After the infusion of the antivenin, her swelling and pleural infusion gradually improved, so she discharged on the seventh hospital day. Even after discharge, she showed no complication with serum sickness. This case showed a favorable course after a second infusion of antivenin using premedication. As there have been few reports of multiple infusions of antivenin for the same patient, a further analysis with the accumulation of similar cases is necessary.

mamushi antivenin adrenaline steroid

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Toh-Yoon, E.W., Otani, Y. and Kabuto, S. “Severe Japanese Mamushi (Gloydius blomhoffii) bite”, Clin Case Rep, 5(9). 1548-49. Jul 2017.
[2]  Ishikawa, K., Ohsaka, H., Omori, K., Obinata, M., Mishima, K., Oode, Y. and Yanagawa, Y. “Pregnant Woman Bitten by a Japanese Mamushi (Gloydius blomhoffii)”, Intern Med, 54(19). 2517-20. Oct 2015.
[3]  Hifumi, T., Yamamoto, A., Morokuma, K, Ogasawara, T., Kiriu, N., Hasegawa, E., Inoue, J., Kato, H., Koido, Y. and Takahashi, M. “Surveillance of the clinical use of mamushi (Gloydius blomhoffii) antivenom in tertiary care centers in Japan”, Jpn J Infect Dis, 64. 373-376, Apr 2011.
[4]  Hifumi T, Yamamoto A, Morokuma K, Okada, I., Kiriu, N., Ogasawara, T., Hasegawa, E., Kato, H., Inoue, J., Koido, Y. and Takahashi, M. “Clinical efficacy of antivenom and cepharanthine for the treatment of Mamushi (Gloydius blomhoffii) bites in tertiary care centers in Japan”, Jpn J Infect Dis, 66(1). 26-31. 2013.
[5]  Maeshiro, Y. “Poisonous snake”, Jpn J Acute Med, 3. 1378-83. 1979. In Japanese
[6]  Naito, H. “Is an antivenom necessary for mamushi bite?”, Jpn Med J, 3986. 24-27. 2000. In Japanese
[7]  Smith, P.K., Hourihane, J.O.B. and Lieberman, P. “Risk multipliers for severe food anaphylaxis”, World Allergy Organ J, 8(1). 30. Nov 2015.
[8]  Tateno, I., Sawai, Y., Makino, M., Kawamura, Z. and Ogonuki, T. “Relapse or reinfection in tetanus and diphtheria, and reenvenomation in mamushi and habu snake bites. Problems associated with reinjection of horse serum antitoxin or antivenom in man”, Jpn J Exp Med, 34. 125-34. Jun 1964.
[9]  Makino, M., Yurugi, E., and Abe, J. “A study of 114 cases of viper bite. With special reference to the administration of antivenin”, J Jpn Surg Assoc, 49.1923-28. 1988. In Japanese.
[10]  Zeng, F.J., Chen, C. and Liu, M.H. “Allergic reactions to antivenom in a patient bitten twice by the same snake within a month: A rare case report and literature review”, Chin J Traumatol, 20(5). 299-302. Oct 2017.
[11]  Takeuchi, I., Omori, K., Nagasawa, H., Jitsuiki, K., Kondo, A., Ohsaka, H., Ishikawa, K. and Yanagawa, Y. “Prognostic indicators among laboratory data on arrival to assess the severity of mamushi bites”, J Rural Med, 14. 222-5. Nov 2019.
[12]  Noda, K., Akiyama, N. and Seishi, I. “The effects of early treatment with anti−venom on length of hospital stay: Analysis of 46 cases of mamushi bites”, Chudoku Kenkyu, 30. 25-30. Mar 2017. In Japanese.
[13]  Ameno, S., Ameno, K., Fuke, C., Kiryu, T., Sogo, K., Yodoya, J., Ijiri, I. and Tsunenari, S. “Detection of anti-horse serum antibody produced by injecting an antivenin or antitoxin”, Nihon Hoigaku Zasshi, 42. 161-8. Apr 1988. In Japanese.
[14]  Otten, E.J. and McKimm, D. “Venomous snakebite in a patient allergic to horse serum”, Ann Emerg Med, 12(10). 624-7. Oct 1983.
[15]  de Silva, H.A., Pathmeswaran, A., Ranasinha, C.D., Jayamanne, S., Samarakoon, S.B., Hittharage, A, Kalupahana, R., Ratnatilaka, G.A., Uluwatthage, W., Aronson, J.K., Armitage, J.M., Lalloo, D.G. and de Silva H.J. “Low-dose adrenaline, promethazine, and hydrocortisone in the prevention of acute adverse reactions to antivenom following snakebite: a randomized, double blind, placebo-controlled trial”, PLoS Med, 8. e1000435. May 2011.
[16]  Sutherland, S.K. “Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits”, Med J Aust, 157. 734-9. Dec 1992.