Rapidly developing and fatal Vibrio vulnificus wound infection

Abstract

A 59 year old male presented at a hospital in September 2013 with a painful blister and significant associated erythema on his right ankle (Fig. 1). The patient complained of an acute burning sensation emanating from his lower ankle. The patient attributed the infection to a possible insect bite, which had subsequently been exposed to seawater during a fishing excursion in the Gulf of Mexico, USA. The infection rapidly progressed (4 h and 15 min between panel A and B), with extensive swelling and erythema of the lesion evident. The patient’s condition subsequently deteriorated, with a rapid and progressive spreading of fluid-filled bullae over the majority of his body surface. Despite aggressive treatment with the antibacterial agents doxycycline, ceftazimide, and clindamycin the patient succumbed to the infection approximately 28 h after admission to hospital. The Gram-negative bacterium Vibrio vulnificus was subsequently isolated. It should be noted that the individual did not have obvious underlying medical conditions, which make this a particularly noteworthy and unusual case.