Hemorrhagic Bullous Cellulitis/Necrotizing Fasciitis of the Foot due to V. fluvialis and Complicated by E. cloacae Osteomyelitis

Vibrio fluvialis (V. fluvialis) is a halophilic bacterium that is most often associated with gastrointestinal tract in- fections after consumption of contaminated seafood. The predominant presenting symptoms of V. Fluvialis infection in- clude explosive diarrhea, vomiting, abdominal pain and dehydration. Vibrio species, V. Fluvialis in particular, are rarely a cause of necrotizing fasciitis. We describe a case of a 56-year-old male presenting with complaints of redness and swel- ling of and discharge from his right toes. The patient was diagnosed with necrotizing fasciitis and septicemia. Debride- ment of the areas proved unsuccessful; amputation of infected phalanges was effective in preventing spread of disease. Cultures were positive for V. fluvialis from the bullae aspirates and Enterobacter cloacae from the bone culture. The pa- tient recovered successfully from both infections. This case is atypical because of the absence of any gastrointestinal symptoms and the presence of necrotizing fasciitis and septicemia due to V. Fluvialis infection.