Arora H, and McHargue C. 28353 Hemorrhagic cellulitis secondary to vibrio fluvialis infection. J Am Acad Dermatol 2021; 85(3):AB184.
Journal of the American Academy of Dermatology
A 75-year-old male with a medical history of heart failure, interstitial lung disease, end stage renal disease on hemodialysis, and carcinoid tumor presented to the ER due to diarrhea and abdominal rash. His abdominal rash started as asymptomatic bruising along the left abdomen which spread to the right. He developed myalgias, lethargy, and altered mental status; he later developed fever, tachycardia, and hypovolemia and was found to be in septic shock. Labwork revealed a leukocytosis with neutrophilic predominance, elevated lactate, and negative Clostridium difficile. Blood cultures grew Gram-negative bacilli which later speciated as Vibrio fluvialis. Biopsy revealed neutrophilic dermatitis and panniculitis with hemorrhage consistent with hemorrhagic cellulitis. The patient was treated with IV piperacillin/tazobactam and oral doxycycline with which he had improvement of his abdominal rash, mental status, and systemic symptoms. V fluvialis is a Gram-negative bacterium which occurs widely in aquatic environments. V fluvialis has been detected in mollusks, oysters, mussels, among other marine creatures commonly consumed as seafood. Upon questioning, this patient did admit to eating uncooked clams three days prior to presentation. This organism is known to cause gastroenteritis with diarrheal illness as in this patient. Cases of peritonitis, suppurative cholangitis, and bacteremia have been noted with V fluvialis. There is one reported case of hemorrhagic cellulitis and cerebritis in a patient who swam in brackish water following multiple fire ant stings. We report a novel case of hemorrhagic cellulitis and bacteremia leading to septic shock secondary to V fluvialis infection following raw clam ingestion.