PMC6470431_01
Blood film taken on day 11 depicting evidence of microangiopathic hemolytic anemia. A nucleated red blood cell is also seen.
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fig1
Her blood picture on day 2 did not show hemolysis and was suggestive of bacterial infection but blood picture on day 5 showed evidence of microangiopathic hemolytic anemia (MAHA), and same changes were there in a blood film taken on day 11, as depicted in Figure 1.
A bulla and tissue necrosis at the site of bite and edema of the right foot (day 6).
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fig2
Local edema at the site of the bite increased with necrosis (Figure 2); thus, wound debridement was done on day 7 and followed up by regular wound toilets.
The offending snake. Large venom glands can be seen (pointed by an arrow). The pattern of scales in the dorsum of the head also contributed to positive identification of the species.
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fig3
Kalana Maduwage, has confirmed it as a Hypnale hypnale.  Figure 3 is a photo of the offending snake.
Photos of the fundi of this patient taken on day 77 after a month of steroid therapy. In the fundus of the right eye (a) and left eye (b), changes are mild after treatment. Bilateral optic disc edema more in the left and hemorrhage near left fundus are seen.
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fig4
Her erythrocyte sedimentation rate and contrast-enhanced computed tomography (CECT) brain done on day 53 were normal.  Figure 4 is a photograph of fundi of this patient.