Vibrio hollisae is a halophilic species that was recently reclassified as Grimontia hollisae. This organism is known to cause moderate to severe cases of gastroenteritis. We report a case of an individual who suffered a more severe form of this disease, presenting with profound hypotension and acute renal failure, secondary to hypovolemic shock.
CASE REPORTA previously healthy, 43-year-old, Vietnamese male presented to the emergency room with several days of persistent severe diarrhea associated with nausea, vomiting, and diffuse, cramping abdominal pain. He denied recent travel, contacts with sick people, or ingestion of raw food. Although initially denying recent consumption of seafood, he later recalled consumption of shellfish. On physical exam, his blood pressure was 60/48 mm Hg, heart rate 120 beats/min, and temperature 98.1°F. He looked acutely ill and was dehydrated. His abdomen had diffuse tenderness to palpation without rebound or guarding, and his stools were positive for occult blood. The remainder of his physical exam was unremarkable. Laboratory results included a leukocyte count of 15,510/mm 3 with 67% polymorphonucleocytes and 17% bands. Blood chemistry results were consistent with acute renal failure and anion gap metabolic acidosis. Two blood cultures, a stool culture, an exam for ova and parasites, a Clostridium difficile toxin assay, and a fecal leukocyte exam were ordered. A computerized axial tomography scan of the abdomen revealed diffusely dilated and edematous small bowel wall. The patient was admitted to the hospital, treated initially with intravenous fluids, and prescribed ciprofloxacin (800 mg/day) and metronidazole (1.5 g/day). He improved significantly, his renal failure resolved, and his vomiting and diarrhea stopped. He was discharged 2 days later on oral antibiotics.Stool test results were positive for fecal leukocytes and negative for ova and parasites and C. difficile toxin A/B. A routine stool culture was negative for Salmonella, Shigella, and Campylobacter spp. However, moderate growth of non-lactose-fermenting gram-negative bacilli on MacConkey agar plates and moderate growth of beta-hemolytic, oxidase-positive gray colonies on sheep blood agar plates were noted after overnight incubation. Poor growth of these colonies was noted upon subsequent subculture to thiosulfate-citrate-bile salts-sucrose (TCBS) agar. An identification of Vibrio hollisae was obtained with a Vitek 2 GNI card (bioMerieux, Inc., Durham, NC) and the BBL Crystal E/NF ID kit (Becton Dickinson Microbiology, Cockeysville, MD). This identification was confirmed by Sharon Abbott, Microbial Disease Laboratory, Division of Communicable Disease Control, California Department of Public Health, Richmond, CA.Susceptibility testing was performed as described for Vibrio species (3) using a MicroScan (Dade Behring, West Sacramento, CA) negative type 30 MIC panel. The MIC test was initially performed using inoculum water with Pleuronic as specified in the Microscan product insert. When the isolate failed to grow, 0.9% ...
