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Images in emergency medicine
Bullous skin lesions in Vibrio vulnificus infection
  1. Noriyuki Umakoshi1,
  2. Akira Kuriyama2
  1. 1Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
  2. 2Department of General Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
  1. Correspondence to Dr Akira Kuriyama, 1-1-1 Miwa Kurashiki Okayama 710-8602 Japan; nrk40448{at}nifty.com

https://doi.org/10.1136/emermed-2012-202098

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    A 75-year-old man presented with acute bullous erythema of the left leg, following fever and diarrhoea. He had no particular medical history or any recent episodes of water activity. The cutaneous lesions were positioned on the lower left thigh and lower thigh, erupted and tender with bullas in its centre (figure 1). Admission blood cultures grew V. vulnificus. Repeat history taking revealed the consumption of raw striped mullet 4 days before disease onset. On the basis of the history and cultures, a diagnosis of primary V. vulnificus septicacemia was established. Primary V. vulnificus septicacemia may develop when individuals with liver disease, haemochromatosis, or immune disorders consume raw or undercooked seafood.1 Patients with V. vulnificus septicacemia often present in shock and develop bullous skin lesions, resulting in high mortality. For this patient, treatment with a broad-spectrum antibiotic was initiated, and the skin lesions and symptoms completely resolved without complications.⇓

    Figure 1
    Figure 1

    Bullous skin lesions on the left thigh and lower thigh.

    Acknowledgments

    The authors would like to sincerely thank Paul Williams for his editing of the article.

    Reference

    1. ↵
      1. Horseman MA,
      2. Surani S
      . A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection. Int J Infect Dis 2011;15:e157–66.
      OpenUrlCrossRefPubMed

    Footnotes

    • Contributors Drs NU and AK looked after the patient, wrote and revised the manuscript, and approved the submission of the current manuscript.

    • Funding None.

    • Competing interests None.

    • Patient's consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.