Images in Clinical Medicine: Vibrio Vulnificus Necrotizing Soft-Tissue Infection

Why It Matters

Rising ocean temperatures broaden Vibrio vulnificus habitats, increasing severe infection risk and straining healthcare resources, especially in coastal regions.

Key Takeaways

• Vibrio vulnificus infection can cause rapid necrotizing tissue loss.
• Warm coastal waters increase risk of severe wound infections.
• Climate change expands Vibrio habitats, raising future case numbers.
• Prompt surgical debridement and antibiotics are critical for survival.
• Amputation may be necessary despite aggressive early treatment.

Summary

A 74‑year‑old man presented with rapidly worsening wounds on his leg and arm after a laceration in Florida’s Gulf waters, ultimately diagnosed with Vibrio vulnificus necrotizing soft‑tissue infection. The case underscores how exposure to warm, low‑salinity coastal water can trigger severe bacterial invasion even in otherwise healthy individuals.

Physical exam revealed painful ecchymosis, crepitus, and skin desquamation; urgent surgical debridement was performed. Blood and tissue cultures grew V. vulnificus, leading to treatment with ceftriaxone and doxycycline. Extensive necrosis required a below‑knee amputation and mesh autografting of the forearm, with graft healing observed six months later.

V. vulnificus thrives in warm, low‑salinity estuarine environments and spreads through contaminated seafood or open wounds exposed to seawater. Researchers project its geographic range and incidence will expand as climate change drives higher water temperatures, altered salinity, storm surges, and algal blooms.

The episode highlights the need for heightened clinical vigilance, rapid surgical intervention, and public‑health strategies that address emerging water‑borne pathogens in a warming climate.

Original Description

After sustaining a laceration while jumping into Coastal Gulf waters, a 74-year-old man presented to the ED with 3 days of worsening painful ecchymosis with crepitus on his right leg and right arm. A diagnosis of 𝘝𝘪𝘣𝘳𝘪𝘰 𝘷𝘶𝘭𝘯𝘪𝘧𝘪𝘤𝘶𝘴 necrotizing soft-tissue infection was made.

Read the full case details in the Images in Clinical Medicine article “𝘝𝘪𝘣𝘳𝘪𝘰 𝘷𝘶𝘭𝘯𝘪𝘧𝘪𝘤𝘶𝘴 Necrotizing Soft-Tissue Infection” from @UFHealth1 at NEJM.org.

This video is part of an #earthday2026 spotlight illustrating the effects of the climate crisis on clinical health. View more resources at NEJM.org.

#climatechange #nejm