Cutaneous Portal: Recurrent Vibrio parahaemolyticus Septicemia in Decompensated Cirrhosis with Chronic Venous Stasis Ulcer Following Marine Exposure
Poster #: 047
Session/Time: B
Author:
Luke Iacovoni Ekdahl, BS
Mentor:
Mark Flemmer, MD
Research Type: Case Report
Abstract
INTRODUCTION:
Recurrent Vibrio parahaemolyticus (V. parahaemolyticus) septicemia is a rarely reported but life-threatening complication in patients with cirrhosis, who are uniquely predisposed to severe bacterial infections due to cirrhosis-associated immune dysfunction and impaired barrier defenses. In this report, we present a unique case of middle-aged patient with decompensated cirrhosis and a chronic venous stasis ulcer who developed recurrent episodes of V. parahaemolyticus septicemia following cutaneous exposure, underscoring the heightened risk of invasive Vibrio infections in this population, particularly for those with frequent estuarian exposure.
CASE INFORMATION:
A 53-year-old male crabber with alcohol-related decompensated cirrhosis (Child-Pugh C), chronic venous stasis, and a history of V. parahaemolyticus septicemia presented with fever, hallucinations, and altered mental status. Vitals were notable for fever, tachycardia, and tachypnea. Labs showed elevated lactate, thrombocytopenia, hyperammonemia, and positive blood cultures for V. parahaemolyticus. Empiric antibiotics were initiated and streamlined to ceftriaxone and doxycycline following sensitivity testing. Workup for septic emboli and endocarditis were negative. The patient subsequently improved with clearance of bacteremia and resolution of encephalopathy.
DISCUSSION/CLINICAL FINDINGS:
V. parahaemolyticus is a halophilic gram-negative bacterium found in brackish and coastal waters and is the most common cause of seafood-related gastroenteritis in the U.S. While it typically causes mild gastrointestinal illness, invasive infections such as cellulitis and septicemia may occur in immunocompromised individuals, particularly those with liver disease. Climate change and the spread of virulent serotypes have led to an increase in both geographic distribution and infection incidence. Unlike the better-known Vibrio vulnificus (V. vulnificus), reports of V. parahaemolyticus septicemia secondary to cutaneous exposure-especially recurrent cases-are rare. While no large-scale studies have been performed for V. parahaemolyticus bacteremia, the antibiotic selection was expanded upon current data for complicated Vibrio infections more broadly, including V. vulnificus septicemia.
CONCLUSION:
This case highlights the need for heightened clinical suspicion for Vibrio species in cirrhotic patients presenting with soft tissue infections or sepsis, especially with relevant environmental exposures, and reinforces the importance of early empiric coverage for Vibrio in at-risk individuals. Awareness of this association is critical for timely diagnosis and intervention, given the fulminant course and high mortality associated with Vibrio bacteremia in cirrhosis. Likewise in the absence of large trials, we provide one example of the use of a third-generation cephalosporin and doxycycline, the regimen for V. vulnificus septicemia, in a complicated V. parahaemolyticus infection.
Recurrent Vibrio parahaemolyticus (V. parahaemolyticus) septicemia is a rarely reported but life-threatening complication in patients with cirrhosis, who are uniquely predisposed to severe bacterial infections due to cirrhosis-associated immune dysfunction and impaired barrier defenses. In this report, we present a unique case of middle-aged patient with decompensated cirrhosis and a chronic venous stasis ulcer who developed recurrent episodes of V. parahaemolyticus septicemia following cutaneous exposure, underscoring the heightened risk of invasive Vibrio infections in this population, particularly for those with frequent estuarian exposure.
CASE INFORMATION:
A 53-year-old male crabber with alcohol-related decompensated cirrhosis (Child-Pugh C), chronic venous stasis, and a history of V. parahaemolyticus septicemia presented with fever, hallucinations, and altered mental status. Vitals were notable for fever, tachycardia, and tachypnea. Labs showed elevated lactate, thrombocytopenia, hyperammonemia, and positive blood cultures for V. parahaemolyticus. Empiric antibiotics were initiated and streamlined to ceftriaxone and doxycycline following sensitivity testing. Workup for septic emboli and endocarditis were negative. The patient subsequently improved with clearance of bacteremia and resolution of encephalopathy.
DISCUSSION/CLINICAL FINDINGS:
V. parahaemolyticus is a halophilic gram-negative bacterium found in brackish and coastal waters and is the most common cause of seafood-related gastroenteritis in the U.S. While it typically causes mild gastrointestinal illness, invasive infections such as cellulitis and septicemia may occur in immunocompromised individuals, particularly those with liver disease. Climate change and the spread of virulent serotypes have led to an increase in both geographic distribution and infection incidence. Unlike the better-known Vibrio vulnificus (V. vulnificus), reports of V. parahaemolyticus septicemia secondary to cutaneous exposure-especially recurrent cases-are rare. While no large-scale studies have been performed for V. parahaemolyticus bacteremia, the antibiotic selection was expanded upon current data for complicated Vibrio infections more broadly, including V. vulnificus septicemia.
CONCLUSION:
This case highlights the need for heightened clinical suspicion for Vibrio species in cirrhotic patients presenting with soft tissue infections or sepsis, especially with relevant environmental exposures, and reinforces the importance of early empiric coverage for Vibrio in at-risk individuals. Awareness of this association is critical for timely diagnosis and intervention, given the fulminant course and high mortality associated with Vibrio bacteremia in cirrhosis. Likewise in the absence of large trials, we provide one example of the use of a third-generation cephalosporin and doxycycline, the regimen for V. vulnificus septicemia, in a complicated V. parahaemolyticus infection.