(597) Terror Beneath the Tides: Vibrio vulnificus Septicemia

Introduction: Undercooked or raw seafood can be contaminated with Vibrio, a bacterial pathogen that can cause septicemia. Exposure of open wounds to seawater containing high Vibrio concentrations can also lead to necrotizing wound infections. In the United States, this bacterial infection is known for having a mortality of 33% and among Vibrio species, Vibrio vulnificus is particularly dangerous often requiring critical care management. Our case involves, an otherwise, healthy elderly woman who developed extensive cutaneous lesions after consuming raw shellfish, later complicated by septic shock requiring ventilatory and hemodynamic support.

Description: Our patient is a 68-year-old female with a medical history of hypertension who presented to the emergency department with sudden onset of atraumatic right upper extremity pain and swelling. Computed tomography of the right extremity demonstrated extensive soft tissue swelling without fluid collection. She was admitted to the general medical floors for management of non-purulent cellulitis. Her stay was complicated by a change in her mentation and hemodynamic instability requiring admission to the ICU. Fluid-filled bullae began to appear throughout the right upper extremity associated with increased swelling. Collateral history revealed a recent exposure to seafood. Immediate fasciotomy demonstrated viable tissue but later blood cultures were positive for Vibrio vulnificus. Despite aggressive management, her course was further complicated by multi-organ dysfunction and clinical deterioration.

Discussion: Vibrio vulnificus is responsible for a majority of seafood-related deaths, and those with immuno-compromising disorders are at the highest risk. The patient in our case who had no known risk factors, did not fit the typical profile for patients presenting with Vibrio vulnificus septicemia. There were no prodromal signs or characteristic skin findings, until later in the ICU, which lowered the index of suspicion and delayed the diagnosis. This clinical presentation along with the patient’s history highlight the importance of prompt recognition of these infections, especially when coupled with systemic decompensation. Doing so, can increase the likelihood of initiating appropriate management to mitigate its devastating consequences.