Vibrio vulnificus Necrotizing Soft Tissue Infection: Institutional Case Report and Ten-Year Systematic Literature Review

Authors:
Susanna Hatcher, Kanhua Yin, Heather Klepacz, James Lau

Body of Abstract:
Background: Necrotizing soft tissue infections (NSTIs) caused by Vibrio vulnificus are rare but highly lethal. Early recognition, even in the setting of atypical presentation, is essential, as is prompt surgical debridement and initiation of appropriate antibiotics. Due to the rarity of this disease, published reports remain limited. In this study, we present an in-house case and perform a systematic literature review of all published cases from the past decade to provide a comprehensive synthesis of current knowledge

Methods: We report an 88-year-old patient with V. vulnificus NSTI who underwent emergent surgical debridement within hours of presentation but succumbed to overwhelming sepsis within 48 hours. We also reviewed eight published case reports and one case-control study involving 45 patients. Extracted data included presenting symptoms, risk factors, timing of surgical debridement, antibiotic regimens, and clinical outcomes

Results: All reported patients underwent urgent surgical debridement and received antibiotic therapy. Our patient experienced rapid deterioration, developing hemorrhagic bullae on the contralateral leg and extensive mottling of the thighs and abdomen shortly after the initial operation. She died two days after presentation despite multiple debridements and appropriate antibiotics. Among the nine case reports (including our case), most patients were middle-to-elderly aged (63 ± 17 years), predominantly male (70%), and commonly presented with hemorrhagic bullae (55%). Four reports (44%) used Gram staining to support early identification of Vibrio species. Six cases (67%) required adjustment of the antibiotic regimen after laboratory confirmation of V. vulnificus. More than half of patients (55%) died despite operative and medical management. Proximal limb involvement may also portend increased mortality. The case-control study found that liver disease and seawater/seafood exposure were significantly associated with V. vulnificus NSTI and that mortality was significantly higher compared with non-Vibrio NSTI

Conclusions: Early recognition of V. vulnificus NSTI requires careful attention to characteristic risk factors and key clinical features, including hemorrhagic bullae, rapidly progressive cellulitis, and exposure to seawater or seafood. Early Gram staining may help guide more targeted antimicrobial therapy. Emergent surgical debridement and appropriate antibiotics remain the backbone of treatment, although mortality remains high.