Shewanella algae Necrotizing Fasciitis and Septic Shock after Elective Cosmetic Surgery: A Potential Emerging Infection.

Shewanella is a Gram-negative bacillus found in marine environments throughout the world. Its role in human pathogenesis has mostly been described in patients with seawater exposures and immunocompromising conditions. We present a case of a previously healthy young woman who presented with fever and weakness 4 days after routine elective plastic surgery. Violaceous bullae were found from her bilateral breasts tracking down to her right thigh, corresponding to surgical sites. Despite linezolid and meropenem administration, the patient had hemodynamic instability, requiring intubation and vasopressor support. Necrotizing fasciitis was diagnosed and underwent emergent surgical debridement. Blood cultures grew Shewanella algae, with intraoperative cultures growing S. algae, Pseudomonas aeruginosa, and Candida parapsilosis. After 11 additional wound debridements and adjustment of antimicrobial therapy, her necrotizing fasciitis resolved; however, she was left with multiple deformities. Although the mechanism of acquisition of this infection is unclear, S. algae should be considered when treating necrotizing wound infections.