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Special Feature
February 1, 2005

Image of the Month—Diagnosis

Arch Surg. 2005;140(2):210. doi:10.1001/archsurg.140.2.210

Answer: Vibrio Cellulitis

Figure 1. Left arm depicting severe necrotizing cellulitis with multiple tense bullae.

Figure 2. Left hand and arm depicting the abrasion responsible for the Vibrio infection and multiple tense bullae.

The patient was given intravenous antibiotics, including doxycycline and ceftazidime, for suspected Vibrio or Aeromonas necrotizing fasciitis; then he was taken to the operating room for emergency surgery. Severe cellulitis was present, but the fascia was normal. After the patient received intravenous antibiotics, the cellulitis gradually improved, and his wound was closed on postoperative day 8. No growth was obtained from the specimens cultured during his operation.

Vibrio(usually V vulnificus or V parahemolyticus) is a gram-negative marine bacillus that is found in coastal and brackish waters and can be concentrated in animals that feed by filtration, such as oysters, clams, and scallops.1 It can cause gastroenteritis or septicemia after the consumption of raw seafood, as well as necrotizing soft-tissue infections following exposure to seawater. The disease is most common in warm climates or during the summer months of temperate climates. Preexisting liver disease, diabetes, or malignancies often occur in afflicted patients.2 The skin infections typically arise after cuts or abrasions are exposed to contaminated seawater. The infected wounds are manifested by edema and bronze discoloration with bullae that are pathognomonic. The infections can range from mild cellulitis to severe and rapidly progressive myositis or fasciitis. Early surgical debridement is often required if necrosis or fasciitis is present. Third-generation cephalosporins (especially ceftazidime) and doxycycline are the antibiotic agents of choice, but various resistance patterns can be encountered.3 The mortality of persons who develop septicemia often exceeds 50%.4

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The Editor welcomes contributions to the “Image of the Month.” Send manuscripts to Archives of Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 759, Baltimore, MD 21205; (443) 287-0026; e-mail: Articles and photographs accepted will bear the contributor’s name. Manuscript criteria and information are per the “Instructions for Authors” for Archives of Surgery. No abstract is needed, and the manuscript should be no more than 3 typewritten pages. There should be a brief introduction, 1 multiple-choice question with 4 possible answers, and the main text. No more than 2 photographs should be submitted. There is no charge for reproduction and printing of color illustrations.

Correspondence: David T. Harrington, MD, Department of Surgery, APC 110, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (

Accepted for Publication: April 27, 2003.

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Penman  ADLanier  DC  JrAvara  WT  III  et al.  Vibrio vulnificus wound infections from the Mississippi Gulf coastal waters: June to August 1993.  South Med J 1995;88531- 533PubMedGoogle ScholarCrossref
Morris  JG  JrBlack  RE Cholera and other vibrioses in the United States.  N Engl J Med 1985;312343- 350PubMedGoogle ScholarCrossref