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Finding EXTRAordinary in the Ordinary

Jason Bryant, NP-C and Tim Platts-Mills, MD are practicing emergency medicine clinicians at Maria Parham Health in Henderson, NC. 

Reason for Visit:
A 73-year-old male presented to the emergency department after sustaining a copperhead snakebite to his right middle finger while gardening. He reported immediate severe pain and rapidly progressive swelling.

Patient Outcome:
The patient experienced a life-threatening anaphylactic reaction shortly after initiation of antivenom, resulting in profound hypotension and tachycardia. Prompt recognition and coordinated emergency management stabilized his condition. He was  later transferred to  a tertiary care center where he safely received an alternative antivenom, resulting in control of venom effects. The patient was discharged in stable condition with preserved limb function and appropriate follow-up care.

Two professional headshots of men in circles on a blurred blue background. The man on the left, Dr. Platts-Mills has a beard and wears a suit; the man on the right, Jason Bryant has a beard and a tie. Two professional headshots of men in circles on a blurred blue background. The man on the left, Dr. Platts-Mills has a beard and wears a suit; the man on the right, Jason Bryant has a beard and a tie.

EXTRAordinary Care

The patient arrived with significant pain, swelling, and ecchymosis of the right middle finger shortly after sustaining a copperhead snakebite while working in his garden. Given the early severity of symptoms, the care team made the decision to initiate antivenom therapy in accordance with clinical guidelines. 

Prior to antivenom administration, allergies, dietary history, and environmental exposures were discussed with the patient. He denied any sensitivity to red meat and reported frequent outdoor activity with a history of multiple tick bites, without awareness of any alpha-gal sensitivity. 

Within minutes of starting the antivenom infusion, the patient developed sudden cardiovascular collapse, including profound hypotension, tachycardia, facial flushing, and loss of responsiveness. Jason Bryant and Dr. Tim Platts-Mills were among clinicians at the bedside and quickly recognized the reaction as a life-threatening emergency. The antivenom infusion was stopped, the IV line was discontinued to prevent further exposure, and the care team moved promptly to stabilize the patient. Subsequent evaluation confirmed an IgE-mediated allergic reaction related to alpha-gal sensitivity. 

Targeted life-saving interventions were initiated, including IV fluids administered under pressure, an IV epinephrine bolus followed by continuous infusion, antihistamines, and corticosteroids. Despite persistent hypotension during the initial minutes, the patient gradually stabilized and regained consciousness. Subsequent testing confirmed an IgE-mediated allergic reaction related to alpha-gal sensitivity. 

Due to intolerance of the initial antivenom and ongoing venom effects, the patient was transferred to a tertiary care center where an alternative antivenom was available. Under close monitoring, he successfully received CroFab without further allergic reaction, resulting in stabilization of swelling and pain. Continued multidisciplinary care, careful reassessment, and coordinated hand surgery follow-up supported his recovery. 

Through swift clinical judgment and coordinated team response, this complex snakebite case resulted in a positive outcome despite a rare and life-threatening complication. This case underscores the importance of screening for alpha-gal sensitivity in regions where tick exposure is common, particularly prior to antivenom administration. 

“This case reflects the very best of emergency medicine—rapid recognition, decisive action, and seamless teamwork. Dr. Platts-Mills and Jason Bryant exemplified outstanding clinical judgment under pressure, and their leadership at the bedside directly translated into an exceptional patient outcome. We are incredibly proud of the care they deliver every day at Maria Parham Health.”

Richard Benson, II, MD, FACEP

Regional Vice President

Hospital Partner

white curved building with light blue windows white curved building with light blue windows

Maria Parham Health, located in Henderson, North Carolina, is a Duke LifePoint hospital serving Vance and surrounding counties. Its 20-bed emergency department treats more than 32,000 patients annually, providing accessible, high-quality emergency care to the region. The hospital is supported by dedicated clinical teams focused on safety, teamwork, and compassionate, patient-centered care.