Abstract Introduction Vibrio vulnificus is a Gram-negative, halophilic bacterium commonly found in warm coastal waters. It is a rare but highly virulent pathogen that can cause severe wound infections, septicemia, and gastroenteritis, particularly in individuals with underlying health conditions such as liver disease, diabetes, or immunosuppression. Case Presentation A 51-year-old male with a primary myelofibrosis complicated by secondary hemochromatosis, hypertension, hyperlipidemia, and human immunodeficiency virus (HIV) not on antiretroviral therapy, presented to the emergency department with myalgias, altered mental status, and fever. Admission vitals notable for: blood pressure: 117/77, heart rate: 144, temperature: 103.7, and respiratory rate: 24. Physical examination revealed diffuse bullae on the bilateral upper and lower extremities with associated sloughing. Labwork revealed leukocytosis (30), lactic acidosis 5, CD4 84, procalcitonin 406, creatine kinase 11,063, creatinine 4.5, Total Bilirubin 1.5, Prothrombin 56.5, INR 5.35, AST 2253 and ALT 2315. Imaging revealed diffuse edema in the tibia/fibula extending to the ankle and no acute intracranial process. The patient was started on broad spectrum antibiotics (Vancomycin, Ceftriaxone, and Ampicillin) and admitted to the medical intensive care unit for septic shock. General surgery was consulted and given no clinical signs for necrotizing fasciitis, recommended wound care and non-operative management. Course complicated by development of renal failure requiring renal replacement therapy, hypotension requiring vasopressor support, ischemic hepatitis prompting initiation of N-acetylcysteine drip, and respiratory failure leading to mechanical ventilation. Blood cultures revealed Vibrio Vulnificus. Infectious Disease was consulted, and antibiotics were switched to Ceftriaxone and Doxycycline. After four days, the patient was extubated, weaned off pressors, and downgraded to the floor where he continued recovery and ultimately discharged home with antiretroviral therapy. Discussion Vibrio vulnificus is a conditionally pathogenic bacterium primarily found in coastal environments. There are two primary routes of infections: consumption and infection through skin or mucous membranes. The former occurs when individuals consume raw or undercooked seafood like oysters and clams. This route is associated with primary Vibrio vulnificus septicemia, which has a high mortality rate, ranging from 50% to 60%. Individuals with chronic liver disease, chronic kidney dysfunction, acquired immunodeficiency syndrome (AIDS), malignancies, and immunosuppression are at a higher risk of contracting Vibrio vulnificus infections. Current guidelines recommend the combination of third-generation cephalosporins with tetracycline-class drugs as the preferred treatment regimen for Vibrio vulnificus infections. This case highlights the importance of early recognition, appropriate antimicrobial therapy, and surgical intervention in improving patient outcomes. This abstract is funded by: None
Monestime et al. (Fri,) studied this question.