Friday, September 12, 2008

Bullous eruption on the beach



A 40-year-old man is brought to the emergency department because of a 1-day history of rapidly progressing pain, swelling, and erythema of his right leg associated with fever, chills, and delirium. The patient was vacationing on the Gulf Coast of Florida and feasting on seafood. One day ago, he noted redness and swelling of his right great toe in an area that had been abraded by an oyster shell. The area of redness quickly spread proximally and has now progressed to the calf. Hemorrhagic bullae formed, the skin on the foot and calf began to darken, and the patient became delirious. Medical history is unremarkable.

On physical examination, the patient is awake but is disoriented and is writhing in pain. Temperature is 39.8 °C (103.6 °F), pulse rate is 122/min, respiration rate is 24/min, and blood pressure is 88/40 mm Hg. The right leg show the changes described above. The remainder of the examination is unremarkable. Labs are notable for Hb:8, WBC: 3,000 with a left shift, platelets: 30,000, S. Na: 119, K: 3 and HCO3: 16.

Which of the following is the most likely pathogen responsible for patients problem?

A. Vibrio vulnificus
B. Mycobacterium Avium Complex
C. Vibrio cholera
D. Vibrio hemolyticus
E. Pasturella Multicoda