Disseminated Infectious Complications Following Snakebite Envenomation: Cervical Epidural Abscess With Compressive Myelopathy, Pelvic Abscess, and Peripheral Osteomyelitis

Abstract

Snakebite envenomation remains a major yet underrecognized public health problem, particularly in tropical and subtropical regions. While systemic toxic effects of envenomation are well described, secondary infectious complications are increasingly recognized as important contributors to morbidity. Most infections remain localized to the bite site; however, disseminated infections involving distant anatomical structures are exceedingly rare. We report the case of a 68-year-old man who developed multifocal severe infectious complications following an unidentified snakebite to the left hand. The patient presented with progressive lower limb weakness and inflammatory changes of the bitten finger. Magnetic resonance imaging of the cervical spine demonstrated prevertebral and posterior epidural abscesses extending from C3 to T1, associated with vertebral inflammatory involvement, severe spinal canal narrowing, spinal cord compression, and compressive cervical myelopathy. Computed tomography of the left hand revealed a soft tissue abscess with destructive osseous changes involving the middle and distal phalanges, consistent with acute osteomyelitis. Additional pelvic magnetic resonance imaging identified a rim-enhancing abscess posterior to the pubic symphysis and anterior to the prostate gland. The patient underwent neurosurgical decompression with spinal stabilization, CT-guided pelvic abscess drainage, and partial amputation of the affected finger because of advanced osteomyelitic destruction. This case highlights the potential for hematogenous dissemination of infection following snake envenomation and emphasizes the diagnostic challenge of distinguishing infectious neurological complications from venom-mediated neurotoxicity. Early imaging evaluation, multidisciplinary management, and prompt surgical intervention are critical to prevent irreversible neurological damage and systemic complications in atypical presentations following snakebite.