Vibrio vulnificus pneumonia with multiorgan failure: a case report and review of the literature

BACKGROUND: Vibrio vulnificus is a gram-negative bacterium causing three clinical syndromes namely, gastrointestinal symptoms, skin sepsis and primary sepsis. Primary sepsis exhibits mortality rates exceeding 50%, particularly in the immunocompromised. Vibrio vulnificus is transmitted via consumption of contaminated seafood and contaminated seawater skin exposure. We describe a rare case of an immunocompetent male presenting with an atypical Vibrio vulnificus infection, culminating in severe pneumonia requiring intensive care. CASE PRESENTATION: A 46 year old Indian male dockyard worker, a non-smoker and teetotaler, of Indian origin presented to the emergency treatment unit of a tertiary care hospital in Sri Lanka, with fever, productive cough with yellow sputum, pleuritic chest pain and tachypnea for five days. He had no gastrointestinal or skin manifestations. His respiratory rate was 38 breaths/min, pulse rate was 120 bpm, blood pressure was 107/75 mmHg and pulse oximetry was 85% on air. Chest X-ray revealed consolidation of the left lung. Empiric intravenous Piperacillin-tazobactam and Clarithromycin were commenced after obtaining blood and sputum cultures. Over the next 24 h, his oxygen requirement rose and as he required vasopressor support, he was admitted to the intensive care unit. He was intubated and bronchoscopy was performed on day two, which demonstrated thick secretions from left upper bronchial segments. His antibiotics were changed to intravenous ceftriaxone and doxycycline following a positive blood culture report of Vibrio vulnificus. He was ventilated for ten days and his intensive care stay was complicated with a non-oliguric acute kidney injury, with serum creatinine rising up to 8.67 mg/dL (0.81–0.44 mg/dL). He developed mild thrombocytopenia with platelets dropping to 115 × 10(3) /uL (150–450 × 10(3)/uL) which resolved spontaneously. Vasopressors were weaned off by day eight and the patient was extubated on day ten. He was discharged from intensive care on day twelve and made a full recovery. CONCLUSIONS: Pneumonia itself is an atypical manifestation of Vibrio vulnificus and furthermore, this patient was immunocompetent and did not exhibit the classical gastro-intestinal and skin manifestations. This case highlights the occurrence of atypical Vibrio sp. infections in patients with high exposure risks and the need for early supportive and appropriate antibiotic therapies.