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Photobacterium damselae and Vibrio harveyi hand infection from marine exposure

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Clinical record

A 75-year-old man presented to the emergency department at our tertiary teaching hospital on 11 April 2014 with a 3-day history of a rapidly enlarging, painful haemorrhagic blister on his right hand. He had caught sea bream while fishing at a southern Sydney beach 3 days earlier, but did not recall any hand trauma. His past medical history was significant only for hypertension (amlodipine 10 mg daily), hypercholesterolaemia (atorvastatin 10 mg daily) and mild penicillin allergy. At presentation, he was febrile (38.3°C), with a tense, tender, 3 × 3 cm haemorrhagic bullous lesion surrounded by erythema and swelling of the hand and forearm with reduced range of wrist movement (Figure, A). Systemic examination was unremarkable. His white cell count was elevated (14.4 × 109/L; reference interval [RI], 3.5–11 × 109/L) with neutrophilia (10.9 × 109/L; RI, 1.7–7 × 109/L), and his C-reactive protein level was 30 mg/L (RI, <3 mg/L). Fluid was aseptically aspirated from the lesion, inoculated into blood culture bottles and incubated in the automated BacT/ALERT 3D system (bioMérieux). Treatment was commenced with doxycycline 100 mg orally 12-hourly and cefazolin 1 g intravenously every 8 hours.

Both aerobic and anaerobic culture bottles returned positive….