J Korean Soc Radiol.  2017 Jan;76(1):54-60. 10.3348/jksr.2017.76.1.54.

MR Imaging Findings of Lower Extremity Sepsis Caused by Vibrio Vulnificus: A Report of Three Cases

• Kim J
• Koh SH
• Min SK
• Lee JA
• Lee K

• KMID: 2365052
• DOI: http://doi.org/10.3348/jksr.2017.76.1.54

Abstract

Lower extremity infection caused by Vibrio vulnificus sepsis is a rapidly progressing fatal condition. Prompt diagnosis followed by early and aggressive treatment with antibiotics and fasciotomy is crucial. In this report, we described lower extremity magnetic resonance (MR) images of three patients with Vibrio vulnificus sepsis. In our cases, MR imaging of lower extremity with Vibrio vulnificus sepsis showed three common findings. First, the MR signal abnormalities appeared simultaneously in all layers, including skin, subcutaneous fat, muscles, and deep fasciae. Second, the inflammation showed symmetry on both legs. Third, none of our cases was accompanied by abscess formation. These imaging features may represent rapid progression of Vibrio vulnificus sepsis and could be helpful for accurate diagnosis, and prompt and aggressive treatment.

MeSH Terms

Abscess
Anti-Bacterial Agents
Diagnosis
Fascia
Humans
Inflammation
Leg
Lower Extremity*
Magnetic Resonance Imaging*
Muscles
Sepsis*
Skin
Soft Tissue Infections
Subcutaneous Fat
Vibrio vulnificus*
Vibrio*
Anti-Bacterial Agents

Figure

• 

  Fig. 1 A 61-year-old man diagnosed as Vibrio vulnificus sepsis (case 1). A. Photograph of bilateral lower extremities demonstrates multifocal erythematous patches, ecchymoses, and cyanotic skin lesions. The upper boundary of the lesion is marked, to determine superior spread of the lesion. B, C. Axial T2-weighted image (B) shows abnormal increased signal intensity in skin, subcutaneous fat, multiple muscles of all compartments, and transverse intermuscular septa (arrows) of both legs. Gadolinum enhanced fat-suppressed T1-weighted image (C) shows enhancement of superficial fascia and transverse intermuscular septa (arrows). There is no abscess in both lower extremities. D. Histologic image of fascial layer of the leg reveals degeneration of fibrous tissue (open arrow) and multifocal neutrophil infiltrations (arrow) (hematoxylin and eosin stain, × 400).

• 

  Fig. 2 A 51-year-old man diagnosed as Vibrio vulnificus sepsis (case 2). A. Photograph of bilateral lower extremities shows multiple petechiae and patches. B, C. Axial T2-weighted image (B) shows multifocal patchy high signal intensity in multiple muscles, intermuscular septa (arrows), and overlying subcutaneous fat and skin of both legs. Gadolinum enhanced fat-suppressed T1-weighted image (C) demonstrates thin enhancement along the transverse and posterior intermuscular septa (arrows). There is no abscess in both lower extremities. D. Histologic image of fascia of the leg reveals vascular congestion in the fascia with perivascular neutrophil infiltrations (open arrows) (hematoxylin and eosin stain, × 100).

• 

  Fig. 3 A 49-year-old man diagnosed as Vibrio vulnificus sepsis (case 3). A, B. Axial T2-weighted MR image (A) shows high signal intensity affecting skin, subcutaneous fat, and multiple muscles, and intermuscular septa (arrows) of both legs. Gadolinum enhanced fat-suppressed T1-weighted image (B) shows mild enhancement of bilateral transverse intermuscular septa (arrows). There is no abscess in both lower extremities. C. Histologic specimen of punch biopsy of the skin lesion in the leg reveals diffusely scattered neutrophils in subcutaneous fat layer (arrow), superficial fascia (dashed arrow), and vascular wall of deep dermis (open arrow) (hematoxylin and eosin stain, × 40). Square box at right below shows histologic specimen (× 12 magnification).

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