A case of necrotizing fasciitis of V.vulnificus occurred in a patient with chronic liver disease
This retrospective analysis examines the diagnosis and treatment of a case of chronic liver disease infected with Vibrio vulnificus,admitted to the First Affiliated Hospital of Hainan Medical University on August 8,2023.The patient,a 34-year-old male fisherman,had chronic viral hepatitis B.He sustained a leg abrasion while fishing on August 3,and developed fever and continuous swelling pain in both lower limbs,more severe in the left limb,on the night of the injury.On the fourth day of the disease,he went to the local hospital where he received antibiotic treatment and was transferred to the First Affiliated Hospital of Hainan Medical College on August 8.Upon admission,the patient exhibited low blood pressure,high lower limb skin temperature,poor peripheral blood transport,visible scab,and signs of infectious shock.Within 12 hours of admission,an abscess incision and drainage procedure was performed on his left calf,along with negative pressure wound therapy,and tissue samples from the infected left lower limb were sent for microbial culture.The pathogen culture indicated a Vibrio vulnificus infection,and the histopathology results confirmed necrotizing fasciitis.Treatment included meropenem combined with vancomycin for infection control,maintenance of blood pressure and electrolyte balance,tenofovir disoproxil fumarate for antiviral therapy,and polyene phosphatidylcholine capsules for liver protection based on the drug sensitivity results.Additionally,levofloxacin and cefotaxime were administered for infection control and debridement was performed based on wound conditions.After 17 days of hospitalization,the infection was substantially controlled,but the liver function enzyme was still higher than the normal level,and the wound still had blood and exudation.The patient and his family members requested discharge;however,due to poor wound healing,he was readmitted on September 11,2023,receiving antiviral and liver preservation treatment.On the fifth day,the secretion culture identified a co-infection with Corynebacterium striatum and Providencia stuartii infection.Corynebacterium striatum was subsequently reported as multidrug-resistant,prompting an immediate switch to sensitive antibiotics and supportive care.Sixteen days after readmission,the patient's general condition improved,but the liver function enzyme levels were still higher than normal,so he was discharged.Four months after discharge,a follow-up phone call revealed that the patient had actively pursued antiviral treatment and abstained from alcohol,showing reasonable wound recovery.The patient's case,with a typical exposure history and clinical manifestations,matches the characteristics of septic shock and necrotizing fasciitis caused by V.vulnificus.Clinically,it is crucial todiagnose and treat V.vulnificus infection early according to its pathological characteristics and clinical characteristics to improve the prognosis of patients.
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