A Case of Vibrio vulnificus Septicemia in a Patient with Gastric Bypass Surgery

Background:Vibrio vulnificus is a pathogen found commonly in raw oysters that rarely causes one of two clinical presentations after ingestion: primary septicemia with associated metastatic soft tissue infections or gastroenteritis. Despite the infrequent incidence of the disease, the mortality rate of primary septicemia approaches 50%. In the affected patient population, the organism survives the gastrointestinal tract despite gastric acid release. Most cases of Vibrio vulnificus primary septicemia are found in those with chronic liver disease, hemochromatosis, or immunodeficiency/immunosuppression. Case Presentation: A 46-year-old Caucasian male with history of a remote Roux-en-Y gastric bypass presented with bilateral lower extremity necrotizing soft tissue infection after ingestion of raw oysters. The patient was emergently debrided and treated with broad-spectrum antibiotics for suspected, and later culture-confirmed, Vibrio vulnificus infection. Despite the patient having none of the well-established risk factors, the patient suffered from multi-system organ failure and disseminated intra-vascular coagulopathy, ultimately resulting in a large ischemic stroke and death. Conclusions: This report demonstrates mortality of a patient with none of the previously identified risk factors for primary septicemia. We propose that decreased gastric acidity associated with Roux-en-Y gastric bypass may be a risk factor for the development of primary septicemia from Vibrio vulnificus and should be investigated further.