Bilateral Orchitis following Hump-Nosed Viper Bite: A Rare Complication with Multi-organ Involvement

Hump nosed viper (Hypnale species) envenomation is an important common cause of systemic envenomation in Sri Lanka and Indian polyvalent antivenom in use does not cover this species. We present a rare case of a 45-year-old previously healthy male who developed severe multiorgan related complications following a hump nosed viper bite to the left foot. Initially presented with localized pain with swelling and clinical course rapidly progressed to acute kidney injury requiring hemodialysis, myocarditis confirmed by ECG and echocardiography and bilateral orchitis with hydrocele.Laboratory investigations revealed rising serum creatinine, elevated liver transaminases, high troponin I levels and hematologic findings consistent with thrombotic microangiopathy. Despite the lack of effective antivenom, the patient was successfully managed through a multidisciplinary approach. Treatment included antibiotics, blood and blood products transfusions and hemodialysis.He showed full recovery with normalization of renal function, cardiac parameters and resolution of testicular swelling on follow up. This case underscores the potential rare and severe systemic complications following hump nosed viper envenomation and highlights the urgent need for species and region specific antivenom in Sri Lanka.