Journal Information
Vol. 106. Issue 9.
Pages 774-775 (November 2015)
Vol. 106. Issue 9.
Pages 774-775 (November 2015)
Case and Research Letters
DOI: 10.1016/j.adengl.2015.09.011
Full text access
Cutaneous Ulcer at the Site of Radiation-Induced Dermatitis Caused by Infection With Vibrio alginolyticus
Úlcera cutánea sobre radiodermitis crónica por Vibrio alginolyticus
Visits
...
M.M. Escuderoa, L.J. del Pozoa,
Corresponding author
lpozoh@gmail.com

Corresponding author.
, E. Juberta, M. Rierab
a Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
b Servicio de Medicina Interna, Hospital Universitari Son Espases, Palma de Mallorca, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Full Text
To the Editor:

We report the case of a 66-year-old man with a painful ulcer that he first noticed on the sole of his left foot 2 months previously. The lesion appeared during the month of August on atrophic and scarred skin that was compatible with chronic radiation-induced dermatitis over an area where 15 years earlier he had received radiation therapy for a skin lesion of unknown origin (no medical or histological data were available). The patient lived on the island of Mallorca and habitually walked along the seashore. He reported no history of diabetes, hypertension, smoking, or other systemic symptoms or conditions of interest.

Examination of the skin revealed an ulcer with yellowish exudate, indurated margins, and atrophic skin in the adjacent areas. A blood workup revealed no leukocytosis or increased C-reactive protein levels. A substantial amount of tissue was taken from the margin and base of the ulcer for biopsy. Histopathology revealed collagenic fibrosis in the dermis and signs of vascular disease but no cellular atypia. These findings were compatible with radiation-induced dermatitis. Neoplastic processes were ruled out. Culture of the exudate revealed Vibrio alginolyticus (Fig. 1). Based on the results of the antibiogram, treatment was started with oral ciprofloxacin. However, the course was indolent, with the formation of a skin abscess (Fig. 1B) and development of osteomyelitis (Fig. 2) requiring admission to hospital. The lesion was debrided, even though no microorganisms grew in the culture. Antibiotic therapy was started with doxycycline and ceftriaxone for 10 days. Progress was good, and the ulcer resolved after 3 months.

Figure 1.

A Growth of colonies of Vibrio alginolyticus in blood agar. B, Cutaneous ulcer on the sole of the left foot on an area of chronic radiation-induced dermatitis. Note the formation of an abscess.

(0.08MB).
Figure 2.

Osteolysis of the heads of the third and fourth metatarsals.

(0.05MB).

V alginolyticus is a Gram-negative rod belonging to the genus Vibrio. It is the most halophilic of the Vibrio species, since it can grow in salt concentrations as high as 10%.1V alginolyticus is pathogenic for humans, although its virulence is low, and it is acquired after exposure to seawater or marine animals. V alginolyticus was the only microorganism isolated in the present case. However, it is often found in association with other Vibrio species such as Vibrio parahaemolyticus or Vibrio vulnificus.2V alginolyticus forms part of the habitual marine flora in temperate and tropical coastal waters. The incidence of infection by this microorganism in humans increases significantly during summer owing to the increase in the temperature of seawater.3 Similarly, the climate change observed in recent years leads us to believe that the density of this bacteria has been increasing both in tropical waters and in the colder waters of northern Europe.4

The microorganism is mainly associated with conjunctivitis, otitis, gastroenteritis, and superinfection of wounds that come into contact with contaminated seawater.5–7 Although its course is usually benign and it responds well to oral antibiotic therapy, cases of bacteremia and necrotizing fasciitis have also been reported.8 Patients usually present some degree of immunosuppression (eg, advanced age, diabetes mellitus, liver disease, or immunosuppressive therapy) that predisposes them to infection.8

Our literature search yielded only 1 other case of osteomyelitis caused by V alginolyticus. The patient had chronic hepatitis C and a surgical wound that became superinfected after exposure to seawater and progressed to involve bone tissue. As in the case we report, the patient's condition resolved with extensive surgical debridement and intravenous antibiotic therapy.9

Ulcers appearing on areas of radiation-induced dermatitis are particularly difficult to manage. Clinically, the skin is atrophic, sclerosed, and lacking adnexa, with altered pigment and telangiectases. Lesions on areas of chronic radiation-induced dermatitis appear at least 2 years after administration of ionizing radiation. The risk of secondary ulcers and cutaneous carcinoma is as high as 20%, since the skin is very deteriorated and chronically inflamed with a limited blood supply. Ulcers resulting from radiation-induced dermatitis usually have irregular margins and a base covered by very adherent yellowish slough. The indurated base of these lesions can lead us to suspect carcinoma. Hypoxia-induced tissue alterations and loss of skin integrity favor the risk of superinfection by various microorganisms.10

In the case we present, the dermatitis lesions remaining after treatment received several years previously are in themselves a predisposing factor and a source of local immunosuppression, thus potentially explaining the poor initial outcome of the ulcer.

In conclusion, this emerging microorganism should be taken into account in patients with infections of the skin and soft tissue who have been in contact with seawater or marine animals.

Acknowledgments

We are grateful to Drs Estrella Rojo and Jordi Reina for their help with this report.

References
[1]
P.A. Blake, R.E. Weaver, D.G. Hollis.
Diseases of humans (other than cholera) caused by vibrios.
Annu Rev Microbiol, 34 (1980), pp. 341-367
[2]
S.J. Rubin, R.C. Tilton.
Isolation of Vibrio alginolyticus from wound infections.
J Clin Microbiol, 2 (1975), pp. 556-558
[3]
J.G. Morris, R.E. Black.
Cholera and other vibrioses in the United States.
N Engl J Med, 312 (1985), pp. 343-350
[4]
G. Sganga, V. Cozza, T. Spanu, P.L. Spada, G. Fadda.
Global climate change and wound care: Case study of an off-season Vibrio alginolyticus infection in a healthy man.
Ostomy Wound Manage, 55 (2009), pp. 60-62
[5]
M. Pezzlo, P.J. Valter, M.J. Burns.
Wound infection associated with Vibrio alginolyticus.
Am J Clinic Pathol, 71 (1979), pp. 476-478
[6]
A. Campanelli, S. Sanchez-Politta, J.H. Saurat.
Cutaneous ulceration after an octopus bite: Infection due to Vibrio alginolyticus, an emerging pathogen.
Ann Dermatol Venereol, 135 (2008), pp. 225-227
[7]
J. Reina, V. Fernández-Baca, A. López.
Acute gastroenteritis caused by Vibrio alginolyticus in an immunocompetent patient.
Clin Infect Dis, 21 (1995), pp. 1044-1045
[8]
P.L. Ho, W.M. Tang, K.S. Lo, K.Y. Yuen.
Necrotizing fascitis due to Vibrio alginolyticus following an injury inflicted by a stringray.
Scand J Infect Dis, 30 (1998), pp. 192-193
[9]
V. Barbarossa, N. Kuèis??ec-Tepes??, E. Aldova, D. Matek, F. Stipoljev.
Ilizarov technique in the treatment of chronic osteomyelitis caused by Vibrio alginolyticus.
Croat Med J, 43 (2002), pp. 346-349
[10]
S.R. Hymes, E.A. Strom, C.F. Fife.
Radiation dermatitis: Clinical presentation, pathophysiology and treatment.
J Am Acad Dermatol, 54 (2006), pp. 28-46

Please cite this article as: Escudero MM, del Pozo LJ, Jubert E, Riera M. Úlcera cutánea sobre radiodermitis crónica por Vibrio alginolyticus. Actas Dermosifiliogr. 2015;106:774–775.

Copyright © 2014. Elsevier España, S.L.U. and AEDV
Idiomas
Actas Dermo-Sifiliográficas (English Edition)

Subscribe to our newsletter

Article options
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
  • Additional material
Tools
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.