Vibrio vulnificus sepsis misdiagnosed as simple deep vein thrombosis.

Abstract

A 46-year-old man was transferred to the emergency department and suspected of having a deep vein thrombosis. The patient reported swelling and pain in both lower legs for 16 hours. His medical history included liver cirrhosis secondary to alcohol. A detailed history revealed raw fish consumption 1 day before admission. Within 2 hours of arrival, several hemorrhagic bullae developed in the color-changed lesions of both lower legs. The patient's level of consciousness deteriorated to a stupor. He was admitted to the intensive care unit. Despite intensive management with a ventilator, fluid resuscitation, vasopressors, and intravenous antibiotics (doxycycline, vancomycin, and a third-generation cephalosporin), the patient died within 23 hours of the onset of symptoms. At 1 day after the death, a blood culture confirmed the clinical diagnosis of Vibrio vulnificus. Emergency physicians should consider Vibrio vulnificus infections in patients with sepsis and severe skin lesions and should assess (from the medical history) risk factors including consumption of raw seafood and direct exposure to seawater. Prompt diagnosis and treatment for Vibrio vulnificus infections can significantly improve the outcome.