About a week back, we had a young lady of 16 years brought
to Emergency Room in a supposedly comatose state after a snake had coiled
around her leg. The patient alone had seen the snake and had told relatives
before she became unconscious that the snake did not bite her.
There were no obvious bite marks and it was not difficult to
come to a conclusion that she was well conscious although appearing a bit
drowsy. She also seemed to have a ptosis which on careful examination was not
there. The clotting time was normal.
The only issue was a low blood pressure reading of 80/40 mm
Hg. We gave her some intravenous fluids and she did not respond to that. And we
concluded that this was her normal blood pressure. Later, we found out that
there were problems in her family and we diagnosed her as having an acute
conversion reaction – a psychological response to difficult situations.
We gave her a small dose of anti-depressant. However, she
did not seem to do fine. She continued to remain drowsy. She could communicate
when we called her. She could even walk to the toilet without help. She also
narrated to us that she was taking some ayurvedic drugs for her psychological
condition.
The next day being a Sunday, we could do any investigations.
Her condition remained the same.
On Monday, we sent a battery of tests – complete blood
count, liver function and renal function.
Her total count came as 1200/cu mm with a predominant
lymphocyte picture. Hemoglobin and platelets were normal. The liver and renal
function also came as normal.
There were only two major things that we were looking at – either
a blood dysgracia most probably secondary to her ayurvedic medications or a
haematological malignancy.
We referred her to a higher centre.
This is the second time that I’ve come across a
suspected snake bite being diagnosed with something else more serious. The
previous time was 4 years back at NJH, when we diagnosed disseminated
tuberculosis in a patient who came with an unknown bite.
