Successful treatment of necrotising fasciitis following cobra bite: a case report

TL;DR

A 72-year-old woman developed necrotising fasciitis after a cobra bite and was successfully treated with surgery and antibiotics.

Contribution

This case report highlights the successful treatment approach for necrotising fasciitis following cobra envenomation.

Findings

Antivenom alone was insufficient to prevent necrotising fasciitis after cobra bite.

Aggressive surgical debridement and antibiotics led to successful recovery.

High-protein diet and multivitamins supported tissue regeneration.

Abstract

Necrotising fasciitis following cobra envenomation is an infrequent but life-threatening complication. We report a case of a 72-year-old woman from Khotang who developed a rapidly progressive, discharging wound on her right foot 3 days after sustaining a cobra bite. Initially treated at a local snakebite center with 30 vials of antivenom, she later presented with tachycardia, low-grade fever, and leukocytosis. Local tissue culture revealed Streptococcus pyogenes, prompting escalation of antibiotics to Piperacillin-Tazobactam. The ensuing extensive tissue necrosis, driven by venom cytotoxicity, facilitated secondary bacterial colonization. Aggressive resuscitation, repeated surgical debridement, and nutritional support with a high-protein diet and multivitamins resulted in robust granulation tissue formation. Definitive reconstruction was achieved with a split-thickness skin graft. This case underscores that while antivenom reverses systemic toxicity, early recognition and prompt surgical intervention are paramount in preventing the devastating progression of local necrosis to necrotising fasciitis.

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