New England Journal of Medicine
71-year-old man presented to the emergency department with a 2-day history of fever and excruciating pain in his left hand that had developed 12 hours after eating raw seafood. He had a history of type 2 diabetes mellitus and hypertension and was undergoing hemodialysis for end-stage renal disease. At the time of presentation, hemorrhagic bullae measuring 3.5 by 4.5 cm had developed on the palm of his left hand (Panel A), and erythematous swelling with confluent tense bullae and ecchymoses had developed on the dorsum of the hand and forearm (Panel B). Surgical intervention was performed urgently, and Vibrio vulnificus was isolated from the bullae. Postoperatively, the patient received intravenous ceftazidime and ciprofloxacin. V. vulnificus can cause skin infections after wound exposure to contaminated seawater, as well as primary septicemia through the consumption of contaminated raw or undercooked seafood. Patients with immunocompromising conditions, including chronic liver disease and cancer, are at increased risk for infection and complications. Despite treatment, the skin lesions progressed to deep necrotic ulcers, and amputation of the left forearm was performed 25 days after presentation. The patient did well after the surgery and was discharged home.
