Hemorrhagic Cellulitis after Consumption of Raw Oysters
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《新英格兰医药杂志》
A 52-year-old man from southern Louisiana with a history of nonalcoholic steatohepatitis presented to the emergency room with a report of severe bilateral lower-leg pain and swelling. He had ingested raw oysters three days before presentation. The pain had increased over the day, and a faint bluish rash had begun to develop on his shins. During the next few hours, the rash became hemorrhagic (Figure), and hypotension developed, with a blood pressure of 60/30 mm Hg. He was treated initially with broad-spectrum antimicrobial therapy, multiple pressors, and mechanical ventilation. Gram-negative rods were seen on Gram's staining (inset), and Vibrio vulnificus was identified from the blood cultures. The patient responded to therapy and was discharged. V. vulnificus exists as a free-living bacterium in warm marine environments such as that of the Gulf Coast during the spring and summer months. This organism becomes concentrated in filter-feeding shellfish, and infections occur after ingestion of contaminated food, such as oysters, or through skin contact with contaminated water, such as that resulting from a hurricane, leading to wound infections. Persons at high risk for serious infection include those with liver disease, diabetes, leukemia, or lymphoma. The mortality rate in patients with primary V. vulnificus septicemia exceeds 40 percent.
Lara M. Falcon, M.D.
Lan Pham, M.D.
Earl K. Long Medical Center
Baton Rouge, LA 70805
Lara M. Falcon, M.D.
Lan Pham, M.D.
Earl K. Long Medical Center
Baton Rouge, LA 70805