Severe septicemia, necrotizing fasciitis, and peritonitis due to Vibrio vulnificus in a patient undergoing continuous ambulatory peritoneal dialysis: a case report.

Abstract

BACKGROUND:

Chronic kidney disease, including end-stage renal disease, has been identified as a possible risk factor for primary septicemia and wound infection by Vibrio vulnificus. However, cases of severe septicemia, necrotizing fasciitis, and peritonitis caused by V. vulnificus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been described. We report a case of severe septicemia, necrotizing fasciitis, and peritonitis due to V. vulnificus in a patient undergoing CAPD after ingesting raw seafood.

CASE PRESENTATION:

A 37-year-old woman undergoing CAPD was admitted to the emergency room due to general weakness, fever, diarrhea, and abdominal pain. Although empirical intraperitoneal antibiotics were administered for the diagnosis of CAPD-related peritonitis, her fever did not subside. On hospital day 3, she had hemorrhagic bullae on both lower legs. We evaluated her recent food history, and found that she ate raw seafood before admission. She underwent emergency fasciotomy on the suspicion of necrotizing fasciitis by V. vulnificus infection. Finally, V. vulnificus was confirmed by 16S ribosomal ribonucleic acid gene sequencing using blood and peritoneal effluent fluid cultures. The administration of intraperitoneal ceftazidime and intravenous ciprofloxacin/ceftriaxone was continued for 4 weeks, and the patient completely recovered.

CONCLUSIONS:

Suspicion of V. vulnificus infection in vulnerable patients who ingest raw seafood is essential for prompt diagnosis, which could significantly improve patient outcomes.

• Authors: Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 15 Pg. 422 (Oct 14 2015) ISSN: 1471-2334 [Electronic] England
• PMID: 26467000 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• RNA, Ribosomal, 16S
• Ceftriaxone
• Ceftazidime

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Ceftazidime (therapeutic use)
• Ceftriaxone (therapeutic use)
• Fasciitis, Necrotizing (diagnosis, etiology)
• Female
• Humans
• Peritoneal Dialysis, Continuous Ambulatory
• Peritonitis (diagnosis, etiology)
• RNA, Ribosomal, 16S (analysis)
• Sepsis (diagnosis, etiology)
• Vibrio Infections (complications, diagnosis, drug therapy)
• Vibrio vulnificus (genetics, isolation & purification)