A Case of Vibrio Vulnificus Septicemia in a Patient with Alcoholic Liver Disease

Abstract

Purpose: A 57 year old male commercial fisherman presented to Leonard J Chabert Medical Center in Houma, Lousiana in the early afternoon complaining of back pain, arm pain and shortness of breath after falling off a fishing pier into (brackish) water earlier that day and suffering lacerations to both of his forearms. He also stated that he swallowed a small amount of water. This patient had no known previous medical history but did not regularly visit a physician. Through his family it was obtained that he had an extensive history of alcohol consumption but had never been diagnosed with advanced liver disease. Physical exam upon presentation was significant for normal vital signs, spider angiomata on chest wall, and erythematous areas on both forearms consistent with cellulitis. His labs were significant for AST 74, ALT 27, Total Bilirubin 3.3, and INR of 1.4 and a WBC count of 7300. His platelet count was 55,000. Cardiac enzymes were negative. He was placed on broad spectrum antiobiotics including doxycycline. Within 6 hours blood cultures were positive for Vibrio vulnificus. In the first 12 hours after admit patient suffered cardiopulmonary arrest but was successfully resuscitated via ACLS protocol. At the time of this abstract submission, the patient is stiill alive but critically ill in the ICU approximately one month after admission. His hospital course has included multi -organ failure including ARDS, renal failure requiring dialysis, and ischemic hepatitis. He did not develop fulminant hepatic failure. He did develop ascites and encephalopathy which have been controlled. His wounds have been extensively debrided and he has undergone amputation of several of his digits. Vibrio vulnificus septicemia is a severe illness often associated in patients with advanced liver disease of any kind most often with alcoholic liver disease. Patients are infected through open wounds in estuarine water and consumption and handling of shellfish. The mortality in patients with advanced liver disease is greater than 50%. It must be considered in any patients with known or suspected liver disease, diabetes, or otherwise compromised immune systems.