Hemorrhagic blisters in fulminant Aeromonas hydrophila bacteremia: Case report and literature review

Yao-tien Chang; Sung-yuan HU; Yao-tien Chang; Sung-yuan HU; Sung-yuan HU; Sung-yuan HU; Sung-yuan HU; Che-an Tsai

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Hemorrhagic blisters in fulminant Aeromonas hydrophila bacteremia: Case report and literature review

Author: Yao-Tien CHANG ¹ ; Sung-Yuan HU ¹ ; Yao-Tien CHANG ² ; Sung-Yuan HU ² ; Sung-Yuan HU ³ ; Sung-Yuan HU ⁴ ; Sung-Yuan HU ⁵ ; Che-An TSAI ⁶
Author Information

1. Department of Emergency Medicine, Taichung Veterans General Hospital
2. Department of Nursing, College of Health, National Taichung University of Science and Technology
3. School of Medicine, Chung Shan Medical University
4. Institute of Medicine, Chung Shan Medical University
5. Department of Nursing, College of Nursing, Central Taiwan University of Science and Technology
6. Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital
Publication Type:Journal Article
Keywords: Aeromonas hydrophila; Bacteremia; End-stage renal disease; Hemorrhagic blister
From: Asian Pacific Journal of Tropical Medicine 2019;12(2):91-94
CountryChina
Language:Chinese
Abstract: The Aeromonas species, belonging to the family Aeromonadaceae, are opportunistic pathogens found in humans with an incidence rate of 76 cases per million inhabitants in Southern Taiwan. The incidence of Aeromonas septicemia is relatively low, accounting for less than 15% of cases. Patients diagnosed with Aeromonas hydrophila bacteremia who were presented with skin blisters and septic shock have been reported to have a mortality rate of 100%. Aeromonas infection must be considered in the differential diagnosis of gangrene-like tissue damage or skin lesions in patients with end-stage renal disease, due to the potential sources of infections. A 49-year-old Taiwanese diabetic woman with end-stage renal disease had underwent regular hemodialysis. She was referred to our hospital due to a one-day course of fever, dyspnea, hypotension, and fulminant hemorrhagic blisters covering her whole body. A physical examination uncovered multiple hemorrhagic blisters, along with a ruptured blister over the lower left leg. Laboratory tests revealed an elevation of liver enzymes, impaired renal function, lactatemia, and high anion-gap metabolic acidosis. Cultures of both blood and hemorrhagic blister fluid grew Aeromonas hydrophila. However, she experienced persistent shock despite aggressive intravenous fluid, empiric antibiotics, and inotropic agents with norepinephrine and dopamine. Early diagnosis and prompt management using intravenous fluids, antibiotics and surgical debridement is recommended in order to improve a patient's survival rate.