Abstract
A previously healthy 60-yaer-old man was transported to our hospital suffering from pain in the left arm and right leg. His arm and leg exhibited purpura. His blood pressure was 138/100 mmHg and body temperature was 35.5°C. Laboratory test showed CRP and CK levels of 16.5 mg/dl and 4,268 U/l, respectively. Right leg angiogram indicated severe arterial spasm of the popliteal artery. Hemodynamics evaluation with a Swan-Ganz catheter demonstrated a low cardiac output and high peripheral vascular resistance. Prostaglandin E1 and antibiotics were administrated and continuous hemodiafiltration was performed, but these approaches were not effective. The purpura and rhabdomyolysis became progressively worse, and the patient died after 18 hrs after admission. Vibrio vulnificus was detected from blood culture. This case was diagnosed as infection with V. vulnificus. The angiogram and hemodynamics suggest that insufficiency of peripheral arterial circulation due to severe vasospasm has a significant connection with the rapid worsening in clinical course.
