Necrotising fasciitis with Vibrio vulnificus: a limb threatening dermatologic complication following exposure to marine life

Abstract

Vibrio vulnificus is a rare cause of necrotising fasciitis. The organism can be found in warm, shallow coastal waters, as well as on shellfish, such as crab, and also filter-feeding molluscs, such as oysters, clams, and scallops. In the USA, it is the leading cause of shellfish related deaths. In individuals with major underlying illnesses, such as liver disease, diabetes mellitus, malignancy, alcoholism, haemochromatosis or chronic renal disease, the organism can lead to a fulminant course with a high degree of mortality. Early antimicrobial treatment and timely surgical interventions can be potentially life preserving in serious infections with V vulnificus. We report a case of an elderly patient with end stage renal disease on haemodialysis who developed necrotising fasciitis with V vulnificus following a puncture injury while cleaning crabs.

Figure 1

Haematoxylin and stain of surgical wound culture showing curved gram-negative rods.

Figure 2

Necrotising fasciitis of left hand 24 h after a penetrating injury to the dorsum of the hand by a crabshell.