Based on genetic studies the genus Echis is divided into 4 clades; E. ocellatus, E. coloratus, E. pyramidum and E. carinatus group. Due to low genetic variability, E. leucogaster is regarded as a subspecies of E. pyramidum. To our knowledge bites by E. leucogaster have not been reported in the medical literature and bites by E. pyramidum are seldom reported. A 67-year-old amateur herpetologist was bitten in his finger by a juvenile E. leucogaster. Bite marks were present. Local effects consisted of erythema with mild swelling. 14 hours post-bite, the patient developed leukocytosis (14 x109/L) and venom induced consumption coagulopathy (VICC); INR >9, aPTT >40 sec., fibrinogen 0.3 g/L and D-dimer >35,000 µg/L. There were no signs of bleeding. 25 hours post-bite, 1 vial EchiTAbG was administered. In response to antivenom, coagulation parameters normalized and fibrinogen reached normal values 2 days later. In de meantime, the patient developed thrombotic microangiopathy; thrombocytopenia (min. 28 x109/L) and an extrinsic, intravascular hemolytic anemia. Schistocytes were present in the blood, haptoglobin conc. <0.1 g/L, Hb dropped to 6.6 mmol/L, Hct 31%, erythrocyte count 3.19 1012/L and LDH peaked at 1079 U/L. Kidney function was deteriorating, eGFR dropped from 89 to 24 mL/min/1.7m2, creatinine concentration increased to 289 µmol/L (max) with good urine output. ADAMTS-13 function was 86%. No additional antivenom was given and no further treatment was necessary. The patient was discharged from hospital 105 hours post-bite while LDH, CK and creatinine were decreasing and haptoglobine was increasing. Thrombocytes was above lower reference value, 153 hours post-bite. Conclusion: our patient developed venom induced consumption coagulopathy (VICC) and venom induced trombotic microangiopathy (VITMA). Antivenom neutralized consumption coagulopathy rapidly but had little to no effect on thrombocytopenia and hemolytic anemia development.