Snake Bites a Frequently-Metaphorical Snake

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“A Viper Bite,” Tajamul Hussain and Rafi A. Jan, New England Journal of Medicine [NEJM], vol. 373, no. 11, September 10, 2015. The authors, at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, report:

“A 46-year-old farmer presented to the emergency department 3 hours after his penis was bitten by a snake while he was urinating in an open field. The snake was identified by the patient as “gunas,” which is the local name of the Levantine viper (Macrovipera lebetina). Physical examination revealed stable vital signs, with a grossly swollen penis and formation of hemorrhagic bullae at the puncture sites (Panel A)…. At 36 hours after the initiation of treatment, the patient’s coagulopathy had resolved and he was discharged home. The swelling subsided 4 days after discharge, with the formation of necrotic tissue at the puncture sites (Panel B). The patient had recovered completely at 2-week follow-up.”