FULMINANT OVERWHELMING NECROTIZING VIBRIO VULNIFICUS SEPSIS SECONDARY TO OYSTER CONSUMPTION

Objectives: Vibrio vulnificus is an opportunistic bacteria typically found in warm, low salinity waters. Transmission of V. vulnificus through open wounds or consumption of seafood can lead to wound infections, sepsis, and potentially death. V. vulnificus is the leading cause of seafood-associated fatality in the United States, responsible for over a dozen deaths per year. However, necrotizing fasciitis is a rare presentation of this infection.

Methods:

Results: 35-year-old man with a history of poly-substance abuse, cirrhosis, and recent oyster consumption presented to the emergency department with acute onset bilateral leg pain associated with rash and fever. He was noted to have patchy non-blanching purplish discoloration and erythema of the bilateral lower legs and found to be acidotic, leukopenic, and hyponatremic with evidence of acute kidney and liver injury. The rash rapidly progressed over the course of six hours to large bullae with extensive necrosis, extending proximally to the level of the abdomen with associated septic shock. He was promptly started on broad spectrum antibiotics and taken for aggressive debridement. He ultimately required bilateral above-the-knee amputations, with wound and blood cultures positive for V. vulnificus. Despite appropriate intervention, he had progressive multi-system organ failure and continued extension of skin lesions. He expired on hospital day seven.

Conclusion: Concurrent necrotizing fasciitis with sepsis secondary to V. vulnificus infection is rare and potentially fatal, as demonstrated in this case. This patient likely contracted V. vulnificus from raw oyster consumption during summer months. Caution should be taken when consuming oysters, especially by individuals predisposed to opportunistic infections, to minimize the potential morbidity and mortality even with appropriate and aggressive intervention.