Necrotizing dermo-hypodermitis due to Vibrio vulnificus.

Background, Vibrio vulnificus is a Gram-negative halophilic pathogen for ma n that can cause septicemia in patients with chronic liver disease. In heal thy subjects, infections are generally local or regional. We report two cas es of necrotizing dermo-hypodermitis due to Vibrio vulnificus. Case reports. The first patient was a 21-year-old fisherman who developed e xtensive necrotizing dermo-hypodermitis 24 hours after a penetrating scratc h with a fish bone. The second patient was also a fisherman. This 35-year-o ld man developed a massive area of necrotic tissue on the left leg, also 48 hours after a penetrating fish bone scratch. Both patients exhibited neutr ophil hyperleukocytosis and thrombocytopenia. Bacteriological study of the pus and damaged tissue identified Vibrio vulnificus. Blood cultures were ne gative. Liver tests and liver ultrasound were normal. The course was favora ble in both cases with antibiotic treatment and excision of the necrotic ti ssue. Discussion. For these two cases of Vibrio vulnificus necrotizing dermo-hypo dermitis, the diagnosis was based on epidemiological, clinical and bacterio logical arguments. Neither of these patients had liver disease, explaining tile limited locoregional nature of the infection. The severity of the skin necrosis and its rapid course are related to the toxins produced by V, vul nificus. Curative medical and surgical care is generally effective in cases without septicemia and prognosis is good. Education of exposed subjects, f ishermen and patients with chronic liver disease, should be helpful for pre vention.