Non O1 Vibrio cholerae as a cause of bacteremic lower limb cellulitis: A case report

Self-limiting gastroenteritis and wound infections in immunocompetent patients are most of the cases involved with Non-O1, non-O139 Vibrio cholerae which its microorganism occasionally accountable for intestinal and extra-intestinal infections. Cellulitis is an infection of the skin and underlying soft tissue mostly affected by bacteria. Diabetic foot ulcer is the most costly and devastating complication of diabetes mellitus.

This following case describes a bacteremic soft tissue infection in a diabetic patient who is 54-year-old male with 6 years of type 2 diabetes mellitus. The patient was treated with surgical debridement of the foot ulcer, calf fasciotomy and medical therapy then he discharged. The next day readmitted with deteriorating of his condition the whole right leg to the level of the knee became ischemic and black with evidence of wet gangrene. A Guillotine above knee amputation was done.

Upon review of literature, we only found few cases have been reported of cellulitis due to V. cholerae. A degree of hepatic impairment or immunocompromised state like Diabetes Mellitus, chronic infections, malignancies, and peripheral vascular disease are seen in the majority of non-gastrointestinal V. cholerae infections which suggests that it should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses.

Cholerae should be included in the differential diagnosis of any bacteremic skin and soft tissue infections especially in elderly, comorbid and immune-compromised patients. Well-timed, proper antibiotic and surgical treatments are important in management of the infection to decrease morbidity and mortality.