Rationale:
Vibrio vulnificus is a gram-negative bacterium that can cause 3 clinical syndromes: gastrointestinal symptoms, skin septicemia, and primary septicemia. V vulnificus infection can induce an exacerbation of liver disease, eventually requiring intensive care for multiorgan failure.
Patient concerns:
A 56-year-old Chinese male who was admitted for left lower limb swelling 5 days after sustaining an injury. His left lower leg was wounded with a machete used for cutting rubber. Notably, this machete had also been previously utilized for cutting seafood. Blood culture results indicated the presence of V vulnificus during the hospitalization. The patient’s condition deteriorated rapidly leading to acute liver failure. Over the ensuing days, the patient experienced separation of tendency of aminotransferase and bilirubin (bilirubin-aminotransferase dissociation), indicative of worsening liver function. Of note, the patient had a history of untreated hepatitis B virus infection and a long drinking history.
Diagnoses:
Acute-on-chronic liver failure following a V vulnificus infection.
Interventions:
We utilized double plasma molecular adsorption system (DPMAS) to address the deterioration of the patient’s liver function.
Outcomes:
After 2 DPMAS treatments, the patient’s liver function showed improvement.
Lessons:
This report underscores the importance of timely and repeated DPMAS treatment of patients with a drinking history or chronic liver disease when they present with V vulnificus septicemia.
