Fernando et al. Journal of Medical Case Reports 2011, 5:171 http://www.jmedicalcasereports.com/content/5/1/171 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Vibrio parahemolyticus septicaemia in a liver transplant patient: a case report Rajeev R Fernando*, Sujatha Krishnan, Morgan G Fairweather and Charles D Ericsson Abstract Introduction: Vibrio parahemolyticus is the leading cause of vibrio-associated gastroenteritis in the United States of America, usually related to poor food handling; only rarely has it been reported to cause serious infections including sepsis and soft tissue infections. In contrast, Vibrio vulnificus is a well-known cause of septicaemia, especially in patients with cirrhosis. We present a patient with V. parahemolyticus sepsis who had an orthotic liver transplant in 2007 and was on immunosuppression for chronic rejection. Clinical suspicion driven by patient presentation, travel to Gulf of Mexico and soft tissue infection resulted in early diagnosis and institution of appropriate antibiotic therapy. Case presentation: A 48 year old Latin American man with a history of chronic kidney disease, orthotic liver transplant in 2007 secondary to alcoholic end stage liver disease on immunosuppressants, and chronic rejection presented to the emergency department with fever, vomiting, abdominal pain, left lower extremity swelling and fluid filled blisters after a fishing trip in the Gulf of Mexico. Samples from the blister and blood grew V. parahemolyticus. The patient was successfully treated with ceftriaxone and ciprofloxacin. Conclusion: Febrile patients with underlying liver disease and/or immunosuppression should be interviewed regarding recent travel to a coastal area and seafood ingestion. If this history is obtained, appropriate empiric antibiotics must be chosen. Patients with liver disease and/or immunosuppresion should be counselled to avoid eating raw or undercooked molluscan shellfish. People can prevent Vibrio sepsis and wound infections by proper cooking of seafood and avoiding exposure of open wounds to seawater or raw shellfish products. Introduction Vibrio parahaemolyticus is a facultative anaerobic gram- negative, flagellated, halophilic, asporogenous, bacterium that inhabits marine and estuarine environments [1]. Despite its broad distribution, V. parahemolyticus infec- tions in the United States of America are most common in individuals living in the states bordering the Gulf of Mexico [2-4]. Water temperature, salinity and turbidity correlate with increased densities of pathogenic V. para- hemolyticus [2,5]. Filter feeding animals such as shellfish, blue crabs, finfish and planktonic copepods concentrate V. parahemolyticus. Consumption of raw or under- cooked seafood or exposure of wounds to warm sea- water may lead to vibrio infections. The most common clinical presentation is self-limited gastroenteritis (59%), but wound infections (34%), primary septicaemia (5%) * Correspondence: Rajeev.Fernando@uth.tmc.edu Department of Internal Medicine, the University of Texas Health Science Center, 6431 Fannin Street, Houston, Texas 77030, USA and other infection sites (2%) may also occur [3]. Per- sons who are immunocompromised or who have liver disease are at particularly high risk for severe vibrio infections. Necrotizing soft tissue infections are excep- tional and may cause significant morbidity and mortality from invasion and destruction of fascial planes as well as the release of cytokines [6,7]. Case presentation A 48 year old Latin American male with a history of chronic kidney disease, orthotic liver transplant in 2007 secondary to alcoholic end stage liver disease and chronic rejection on immunosuppressants (tacrolimus, sirolimus, prednisone and mycophenolate mofetil) pre- sented to the emergency department. Two days prior to presentation, patient returned from a fishing trip in the Gulf of Mexico and began to experience fever with chills, vomiting, abdominal pain, left lower extremity pain and swelling. On the evening of his admission he © 2011 Fernando et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.