title: Severe septicemia, necrotizing fasciitis, and peritonitis due to Vibrio vulnificus in a patient undergoing continuous ambulatory peritoneal dialysis: a case report.
abstract: BACKGROUND
  Chronic kidney disease, including end-stage renal disease, has been identified as a possible risk factor for primary septicemia and wound infection by Vibrio vulnificus. However, cases of severe septicemia, necrotizing fasciitis, and peritonitis caused by V. vulnificus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been described. We report a case of severe septicemia, necrotizing fasciitis, and peritonitis due to V. vulnificus in a patient undergoing CAPD after ingesting raw seafood.
  
  
  METHODS
  A 37-year-old woman undergoing CAPD was admitted to the emergency room due to general weakness, fever, diarrhea, and abdominal pain. Although empirical intraperitoneal antibiotics were administered for the diagnosis of CAPD-related peritonitis, her fever did not subside. On hospital day 3, she had hemorrhagic bullae on both lower legs. We evaluated her recent food history, and found that she ate raw seafood before admission. She underwent emergency fasciotomy on the suspicion of necrotizing fasciitis by V. vulnificus infection. Finally, V. vulnificus was confirmed by 16S ribosomal ribonucleic acid gene sequencing using blood and peritoneal effluent fluid cultures. The administration of intraperitoneal ceftazidime and intravenous ciprofloxacin/ceftriaxone was continued for 4 weeks, and the patient completely recovered.
  
  
  CONCLUSIONS
  Suspicion of V. vulnificus infection in vulnerable patients who ingest raw seafood is essential for prompt diagnosis, which could significantly improve patient outcomes.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea. laminion@hanmail.net.
authors.forename: Chang Seong
authors.initials: CS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea. baedak@hanmail.net.
authors.forename: Eun Hui
authors.initials: EH
authors.lastname: Bae
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea. drmsk@hanmail.net.
authors.forename: Seong Kwon
authors.initials: SK
authors.lastname: Ma
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, 42 Jebongro, Gwangju, 501-757, South Korea. skimw@chonnam.ac.kr.
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology; D012336:RNA, Ribosomal, 16S / Q000032:analysis; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology; D014735:Vibrio Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D041261:Vibrio vulnificus / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D012336:RNA, Ribosomal, 16S; D002443:Ceftriaxone; D002442:Ceftazidime