Hemorrhagic Cellulitis after Consumption of Raw Oysters

Abstract

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 . . .