Snapshot A 45-year-old woman presents to a local hospital in Mexico with a swollen, erythematous left ankle. She reports that she recently obtained a tattoo on her left ankle 5 days ago. Since then, she went to Mexico on vacation, swam in seawater, and ate copious amounts of seafood, including raw oysters and ceviche. On physical exam, she has a warm and erythematous plaque over her left ankle where her tattoo is located and has 2 red bullae. Wound cultures are sent to the laboratory and she is started on the appropriate antibiotics. (Vibrio vulnificus infection) Introduction Classification a facultative anaerobe, gram-negative bacillus found in raw shellfish, sediment, and seawater Vibrio vulnificus gastroenteritis necrotizing fasciitis cellulitis Vibrio parahaemolyticus gastroenteritis Epidemiology incidence more common in warm weather V. vulnificus is the most common cause of death from seafood consumption in the US V. parahaemolyticus is the most common cause of diarrhea in Japan risk factors eating undercooked seafood chronic liver disease in particular, cirrhosis disorders of iron metabolism immunocompromised status shucking oysters tsunami organism can infect current wounds Pathogenesis infects via contaminated seafood or direct contact in the case of wound infections Prevention ensure properly cooked seafood Prognosis typically resolves with treatment mortality is high in those who develop septic shock Presentation Symptoms vomiting diarrhea abdominal pain Physical exam may have bullae on skin that progress to necrotic ulcers Studies Labs stool studies wound culture blood culture Making the diagnosis based on clinical presentation and laboratory studies Differential Viral gastroenteritis distinguishing factor typically does not present with skin lesions such as bullae not associated with seawater or seafood Treatment Conservative supportive care indication all patients modalities intravenous hydration Medical doxycycline indication all patients Operative surgical debridement indication necrotizing fasciitis Complications Septic shock