An Insidious yet Rapidly Progressive Vibrio vulnificus Bloodstream Infection: A Case Report.

We report a 35-year-old man with chronic hepatitis B infection and decompensated liver cirrhosis who presented with an 8-month history of progressive fatigue, exertional limb weakness, anorexia, and dark urine, which partially improved following hepatoprotective and anti-cholestatic therapy. One day before admission, his condition deteriorated abruptly, with fever, chills, diarrhea, profound fatigue, and rapidly progressive bilateral lower-extremity edema. Laboratory evaluation revealed severe systemic inflammation and coagulopathy, including a white blood cell count of 8.4×109/L with neutrophil predominance (absolute neutrophil count, 7.6×109/L; neutrophil percentage, 90.7%), severe thrombocytopenia (23×109/L), markedly elevated inflammatory markers (C-reactive protein, 68.7 mg/L; procalcitonin, 5.81 ng/mL; interleukin-6, >5,000 pg/mL), hypoalbuminemia, and prolonged prothrombin time. Empirical antimicrobial therapy was initiated immediately. Blood cultures obtained on admission became positive within 24 hours and were subsequently identified as Vibrio vulnificus. Antimicrobial therapy was adjusted according to susceptibility testing, and surgical incision, drainage, and debridement were performed for progressive lower-extremity soft tissue infection. The patient gradually improved after pathogen-directed antimicrobial therapy and surgical source control and was discharged after clinical stabilization. This case highlights the importance of early recognition, appropriate antimicrobial therapy, and timely surgical intervention in severe V. vulnificus infection, particularly among patients with underlying liver disease.