Abstract
We report on a 49-year-old male patient with untreated alcoholic liver disease who presented with necrotizing soft tissue infection due to Aeromonas sobria. He complained of painful swelling in his upper and lower extremities after eating sushi. On admission, his systolic blood pressure was 92mmHg, heart rate 116·min-1, and body temperature 39.8°C. The patient was confused, cyanotic, and icteric. Marked swelling was observed in all extremities. He had purpura with subcutaneous emphysema in the right femoral region and purpura with hemorrhagic bulla on the left lower extremity. The liver was palpable at three fingerbreadths. Gram-negative rods were detected from the biopsy tissues of the right femoral purpura and sputum. Because we suspected bacteremia and soft tissue infection from the presence of gram-negative rods, we began chemotherapy with imipenem, minocycline and hemo-adsorption, using polymyxin B-immobilized fibers for suspected endotoxemia. Despite extensive treatment with inotrops, antibiotics, hemo-adsorption, and hemofiltration, the patient went into acute renal failure and died 28 hours after admission to the ICU. Aeromonas sobria was isolated from cultures of the blood, sputum, and subcutaneous samples. Autopsy revealed soft tissue necrosis, segmental necrotizing gastroenteritis with bacterial colonies, and alcoholic liver cirrhosis. We would not usually expect the infecting organism of sepsis or soft tissue infection to be Aeromonas sobria in a patient with alcoholic liver cirrhosis. This case of soft tissue infection due to Aeromonas sobria with immunosuppression followed a severe clinical course, alerting us to the need for careful treatment of infections of this type.
