Late-onset Vibrio vulnificus septicemia without cirrhosis

Abstract

Recent surveillance from the Centers for Disease Control and Prevention indicates rising annual incidence rates of Vibrio vulnificus infection. Unfortunately, this infection is often excluded from the differential diagnosis in lesser known at-risk populations. Transmission occurs via wound exposure or ingestion, with V. vulnificus foodborne illness having the highest mortality rate of all Vibrio species. Fatality rates of V. vulnificus rival those of Ebola and bubonic plague, so timely treatment is imperative. Current literature favors surgical debridement with a third-generation cephalosporin plus intravenous doxycycline or fluoroquinolone. Cephalosporin monotherapy is discouraged due to rising resistance. This case features V. vulnificus septicemia with prolonged incubation time in a noncirrhotic patient.

Keywords: Necrotizing fasciitis; Vibrio infections; Vibrio vulnificus; septicemia.

Figure 1.

Right lower extremity (a) at emergency department triage, with nonblanching, erythematous patches and hemorrhagic bullae and (b) on hospital day 4, with clinical decompensation with ecchymoses and enlarging bullae.