• Ahmad Khaldun Ismail, Scott A Weinstein, Mark Auliya, Dazlin Masdiana Sabardin, Teodoro J Herbosa, Ismail Mohd Saiboon, and Julian White.
• Department of Emergency Medicine, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia. khaldun_ismail@yahoo.com
• Clin Toxicol (Phila). 2010 Mar 1;48(3):222-6.

IntroductionThe Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species.Case ReportThe patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis.DiscussionThe properties of Duvernoy's secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia.ConclusionSuch a facility could expedite safe and appropriate management of envenomed patients.

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