Occult neuroparalytic snakebite: A diagnostic challenge

Occult neuroparalytic snakebite: A diagnostic challenge - A 48-year-old woman with hypothyroidism presented with sudden hives and itching, later developing quadriparesis and reduced responsiveness. Initially treated for an allergic reaction, she was brought to the emergency department with respiratory distress, ptosis, and quadriparesis. Primary investigations, including arterial blood gas, magnetic resonance imaging, and cerebrospinal fluid studies, were unremarkable. Suspecting an occult neuroparalytic snakebite, she received 20 vials of antivenom with atropine and neostigmine, resulting in gradual improvement. She was extubated on day 6 and discharged on day 10 with full recovery. The case highlights the need to consider snakebites in unexplained neuroparalysis. Keywords: Occult snake bite, Neuroparalysis, Poisoning, Antisnake venom.