Factitious snake envenomation and narcotic-seeking behavior

United States Poison Control Centers (PCCs) recorded nearly 7000 snakebites in 2013. We present a case of a factitious snakebite in a patient with a pattern of similar emergency department (ED) visits. A 47-year-old man presented to the ED with 5 snakebites on both forearms. He reported being bittenwhile milking venomfroman eastern diamondback rattlesnake for the zoo. On ED arrival, he had punctures on both forearms, swelling on the right forearm, tachycardia, and leukocytosis. He requested CroFab (Crotalidae Polyvalent Immune Fab) and pain medication. Contact with the PCC revealed numerous similar visits at other EDs across the state and an adjacent state. In a series of at least 12 encounters, he received a total of at least 42 vials of antivenom without documented allergic reaction. The PCC recommendations curtailed his receipt of antivenom in later visits. This is an unusual case of repeated factitious snake envenomation. His misuse of epinephrine autoinjectors mimicked symptoms of envenomation. CroFab is an expensive antidote with a potential risk of sensitization with multiple exposures and is best reserved for patientswith true pit viper envenomation. Astute PCC specialists detected the repetitive pattern of his ED visits and helped to reduce unnecessary treatment in later visits.Our patient had factitious disorder and narcotic-seeking behaviorwith repeated ED visits and hospital admissions for alleged pit viper bites. Poison Control Centers play an essential role in detecting patterns of abuse in individuals who change location frequently.