Case 160. Vibrio vulnificus infection (56 y-o M)
         
    Skin biopsy from the lethal gangrene of the thigh without gas formation, seen in a cirrhotic patient    
         
   
Key words : Vibrio vulnificus, gangrenous cellulitis, liver cirrhosis
   
         
   
   
     
 
     
At a low powered view, mild perivascular inflammatory infiltation is noted (HE).   High power magnification reveals numerous capsule-forming coccoid microbes in the dermal and subcutaneous connective tissue (HE, high power). Cellular reaction is poor.
     
 
     
Giemsa stain clearly discloses the distribution of capsuled short rods among the connective tissue.   The microbes are Gram-negative (Gram). Cirrhotic patients with high serum iron levels are particularly susceptible to Vibrio vulnificus. The patient ate uncooled raw oyster.
     
   
     
Reference case 160A
Lethal necrotizing fasciitis of the left arm seen in a 75 y-o cirrhotic patient who cut his left third finger during cooking raw fish (Sashimi). Debridment specimen was submitted for histologic examination. Necrohemorrhagic change with poor cellular reaction is observed (HE). There are two transmission pathways of V. vulnificus which is seen in the sea food. One is transenteric, and the other is traumatic.