Delayed diagnosis and misdiagnosis of snakebite envenomation in the emergency department: A case series of five patients and their clinical consequences

Snakebite is a significant public health problem, particularly in the Eastern Mediterranean and South-eastern Anatolia regions of Turkey. One of the most critical variables determining clinical outcome is the timely initiation of diagnosis and antivenom therapy. In this case series, we present five snakebite cases whose diagnosis was delayed or incorrect at the healthcare facility where they first presented, and who subsequently presented to our clinic, with the aim of discussing the adverse effects of diagnostic delay and misdiagnosis on clinical course in light of the current literature. Five patients aged 30-70 years, three female and two male, were evaluated. All patients had been discharged from outside centres at their first presentation either with symptomatic treatment alone or with incomplete staging and misdiagnosis; they re-presented to our clinic within 1-6 days with increasing local and/or systemic complaints. Patients received snake antivenom at doses ranging from 2 to 17 vials; one case developed sepsis and tissue necrosis, one case had suspected compartment syndrome, and one case developed progressive coagulopathy (INR 7.29), acute kidney injury, and myocardial involvement. This last case died following multiple organ dysfunction and cardiac arrest. The other four cases were discharged in full recovery. Delayed diagnosis in snakebite may be associated with increased local tissue damage and systemic complications, higher antivenom dose requirements, and prolonged hospital stay; in severe cases, delayed recognition may also contribute to poor outcomes. Increasing the awareness of primary care and rural physicians regarding snakebite staging systems and envenomation findings is critically important for preventing possible morbidity and mortality.