Vibrio vulnificus infection in Southern Brazil - Case report
A 39-year-old male patient, diagnosed with ulcerative colitis and sclerosing cholangitis\n10 years ago, was admitted to the hospital for elective liver transplantation. The\npatient was taking azathioprine 100mg/d, ursacol 1.2 g/d, prednisone 10mg/d, simvastatin\n20 mg/d, spironolactone 100mg/d, folic acid and calcium carbonate. On admission his\ngeneral condition was good, and he had a healthy skin tone, was well hydrated,\nfeverless, jaundiced +++/IV, with stable vital signs. On physical examination, he had\ntarget painless hepatomegaly, spider veins and lower limb edema. Twelve hours after\nadmission, the patient had high fever, tachycardia, myalgia in the calves and\nanuria.\nCeftriaxone was empirically started. Within hours, lesions resembling purplish\nerythematous plaques occurred on the lower limbs, with rapid growth and proximal\nprogression.\nThe patient reported a recent trip to the coastal area of the State of Paraná, one day\nbefore the admission. Samples for leptospirosis, dengue, yellow fever, spotted fever and\nmeningococcemia were collected and were found to be negative.\nThe patient became unresponsive to volume, had dyspnea and respiratory distress. He was\ntransferred to the ICU and needed vasoactive drugs and mechanical ventilation. His\nclinical condition progressively worsened associated with increased need for vasoactive\ndrugs. The skin lesions became confluent, forming blisters, and there was discharge of\nsero-sanguineous fluids (). Therapy with\nceftriaxone was changed to meropenem and oxacillin. Blood cultures revealed growth of a\ngram-negative bacillus, which was later identified as Vibrio\nvulnificus. Approximately 32 hours after the onset of infection, the patient\ndied.