Challenges of a West African green mamba (Dendroaspis viridis) envenomation in a European urban setting: A case report with quantitative monitoring of neuromuscular transmission

Although rare, exotic snakebites are a growing medical concern worldwide, partly due to the rising popularity of exotic pet ownership in high-income countries. Envenomation from family Elapidae snakes may cause severe neurological and local symptoms. Timely antivenom administration is crucial, but often complicated by logistical challenges. We report a case of a West African green mamba (Dendroaspis viridis) envenomation in a 59-year-old male in Switzerland who developed progressive weakness and respiratory failure, associated with swelling of a limb. Quantitative neuromuscular stimulation, also known as a train-of-four monitor, was used to assess neuromuscular transmission after antivenom administration. This case highlights the clinical and organizational challenges following an exotic snakebite.