Extensive Tissue Necrosis of the Lower Limb in an 11-Year-Old Boy Who Had Been Bitten Two Weeks Earlier by a Bothrops 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)
Source: Gutièrrez et al. 2006 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030150