# Delayed Onset of Symptoms After a Rattlesnake Bite in a Renal Transplant Patient: A Case Report

## TL;DR

A kidney transplant patient showed snakebite symptoms 18 hours after the bite, possibly due to immunosuppressive drugs delaying the reaction.

## Contribution

This is the first reported case of delayed envenomation symptoms in a renal transplant patient.

## Key findings

- A renal transplant patient showed delayed envenomation symptoms 18 hours after a rattlesnake bite.
- The patient's immunosuppressive regimen may have contributed to the delayed onset of symptoms.
- The patient recovered well after receiving antivenom and was discharged on day three.

## Abstract

The United States is home to two major families of venomous snakes, Crotalids and Elapids. The Crotalid family, also known as pit vipers, is well known for being among the most frequent causes of snakebites reported. Crotalid envenomation can present with local findings, hematologic toxicity, and systemic toxicity. Identification of envenomated patients is key to determining who needs antivenom. Most sources recommend an observation period of six to eight hours after the snakebite to determine whether the bite was “dry” or the patient was exposed to venom.

We present the case of a 33-year-old patient with a history of renal transplantation who had delayed onset of symptoms of envenomation 18 hours after an initial emergency department observation. The patient did well after a course of antivenom and was discharged on hospital day three.

The patient’s immunosuppressive regimen may have delayed the onset of clinical symptoms, thus delaying treatment. To the best of our knowledge, this is the first case reported of a patient presenting with a delayed onset of initial snakebite envenomation symptoms.