Extensive Tissue Necrosis of the Lower Limb in an 11-Year-Old Boy Who Had Been Bitten Two Weeks Earlier by a B. asper in Ecuador

Only antibiotic treatment had been given, so tissue damage was extensive, requiring above-knee amputation. Such pathological alterations are caused by the direct action of locally acting toxins in the venom (mostly metalloproteinases and phospholipases A₂), together with an indirect effect promoted by local inflammatory events and ischemia secondary to venom-induced vascular damage and increased intracompartmental pressure. (Image: D. A. Warrell)