J Korean Soc Emerg Med.  2017 Feb;28(1):133-137. 10.0000/jksem.2017.28.1.133.

A Case of Vibrio vulnificus Sepsis: A Potential Use of Extracorporeal Membrane Oxygenation

• Park SY
• Nam H
• Park S
• Park JY
• Ha SO
• Lee SH
• Kim HS

• KMID: 2425187
• DOI: http://doi.org/10.0000/jksem.2017.28.1.133

Abstract

Necrotizing fasciitis caused by Vibrio vulnificus can rapidly progress to septic shock and death. Hence, early surgical debridement of the involved tissue is vital. However, this can be a challenging task due to the coagulopathy and unstable conditions often associated with these patients. Herein, we present a patient with necrotizing fasciitis caused by V. vulnificus who received extracorporeal membrane oxygenation (ECMO) support for refractory hypotension. After initiating ECMO, his vital signs stabilized, and lactate, C-reactive protein, and procalcitonin levels continued to decrease. He underwent several rounds of surgical debridement and vacuum-assisted drainage on both lower legs. On ECMO day 15, he was successfully weaned off the device and his condition was uneventful for several days. However, on the 24th day of intensive care unit (ICU), he was again placed on ECMO due to clinical deterioration. On ICU day 32, he underwent bilateral below-knee amputations due to delayed wound healing. Unfortunately, he subsequently developed multi-organ failure and died. Nonetheless, this case is instructive regarding the potential use of ECMO. We suggest that ECMO could provide the necessary time for sepsis patients to undergo aggressive medical and surgical interventions.

Keyword

Extracorporeal membrane oxygenation; Fasciitis; necrotizing; Sepsis; Vibrio vulnificus

MeSH Terms

Amputation
C-Reactive Protein
Debridement
Drainage
Extracorporeal Membrane Oxygenation*
Fasciitis
Fasciitis, Necrotizing
Humans
Hypotension
Intensive Care Units
Lactic Acid
Leg
Sepsis*
Shock, Septic
Vibrio vulnificus*
Vibrio*
Vital Signs
Wound Healing
C-Reactive Protein
Lactic Acid