Vibrio Vulnificus: Management of Classic Skin Lesions in Severe Infection

Introduction: Classic skin lesions in vibrio vulnificus infection are comprised of extensive hemorrhagic bullae. The mainstay of treatment is antibiotic therapy, and in high risk patients, surgical debridement may be required. However, in lesions that do not require debridement, there is no protocol in place for appropriate wound therapy.

Case Description: A 75 year old man presented to his primary care provider’s office with bilateral upper extremity cellulitis consisting of fluid-filled lesions which had ruptured. Two days prior to presenting to his primary care provider’s office, he had been fishing in salt water, and also cleaned fish in salt water. He had no known open wounds, although he stated that his cat had bitten him two weeks prior to developing the cellulitis.

After noting unstable vitals, his primary care provider sent him to the emergency department, and from there he was directly admitted to the hospital for septic shock secondary to bacteremia and cellulitis. Plastic surgery did not see an indication for aggressive debridement, as there was no necrotizing fasciitis or abscess seen on X-ray or CT scan of his bilateral upper extremities. The wound care inpatient team was then consulted for management of the ruptured lesions. Manuka honey gel and non-adherent dressings were initiated to the wound beds of his bilateral upper extremities. His wounds did heal with this treatment within 6 weeks. Unfortunately, he did develop lymphedema of his bilateral upper extremities, for which he now sees a lymphedema specialist.

Discussion: This case illustrates one potential treatment for skin lesions of vibrio vulnificus. It also highlights the potential for severe infection to cause a secondary lymphedema.