Figure 1.

A 51-year-old male was bitten over the right thumb distal phalanx by N. atra, which was identified by the patient. (A) Nine hours post-bite, the fang maker (arrow) was located over the radial side, and redness was located over the dorsal side of the thumb. (B) Fifteen hours post-bite, the necrotic change can be noted over the fang marker, and the redness is still noted over the dorsal side of the thumb. (C) Fifty-seven hours post-bite, the progress of necrosis was noted from the fang marker and progressing to dorsal side. (D) (Photo credits: Yu-Jen Shih) Ten days post-bite, the patient received the third time of debridement, and the necrotic tissue was all debrided and removed.