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Abstract: A 23-year-old man living in Orange County, California who was involved in a motor vehicle accident suffered a closed both-bone forearm fracture that was treated with open reduction and internal fixation. The patient then developed wound necrosis and abscesses that revealed a pure culture of non-toxigenic Vibrio cholerae. The wound required debridement and excision, which was followed by split-thickness skin grafting. He also received antibiotics and eventually fully recovered.

Address correspondence to:
Garrett A. Wirth, MD, MS, FACS
University of California, Irvine Medical Center
Aesthetic and Plastic Surgery Institute
200 S. Manchester Ave., Suite 650
Orange, CA 92868
Email: gwirth@uci.edu

     Vibrio cholerae non-O1 serotype has been reported to cause a broad spectrum of illnesses including: bacteremia, central nervous system infections, pulmonary infection, gastrointestinal disease, and skin and skin structure infections, such as cellulitis, wound infections, and necrotizing fasciitis.^1–10 Most skin and skin structure infections are related to direct exposure to fresh, brackish, or salt water.^6–10 Most cases are found in patients who also have underlying liver disease or are in a known immunocompromised state.^11–16 The authors present a case of necrotizing wound infection caused by Vibrio cholerae non-O1 serotype in a patient with no known immunocompromising illness or liver disease. A review of the literature for similarly reported cases will also be presented.

Case Report

     A 23-year-old Hispanic man was brought in by ambulance as a trauma activation following a motor vehicle accident with closed distal diaphyseal fractures of the left radius and ulna in addition to having multiple abrasions on both the dorsal and volar aspects of his forearm (Figures 1–2). In the emergency department the patient was neurovascularly intact and compartment syndrome was not clinically evident. The patient’s injury was temporarily stabilized with a splint until other injuries were ruled out and until the trauma service granted surgical clearance. Next the patient was taken to the operating room for definitive treatment where open reduction and internal fixation were performed (Figure 3). There were no perioperative complications and no cultures were taken at that time.

     The patient’s medical, surgical, and social history were unremarkable. He had not been taking any medications and denied any drug allergies. The patient also ruled out any abusive behavior with drugs or alcohol, prior or current diarrhea, gastrointestinal symptoms, or liver disease. Further patient history revealed that the patient was originally from Mexico and had lived in Orange County, California for the past 5 years.

     He denied having eaten any shellfish for at least 2 weeks prior to the accident, although he had often eaten shellfish in the past. In the accident, the patient’s vehicle rolled into the Santa Ana River, a concrete-lined riverbed and flood control channel, which drains a large watershed from the San Bernardino Mountains. The site of the accident was close to 10 miles inland from the Pacific Ocean. At the time of the accident both the water level and flow were low. The patient reported that the vehicle landed upside down in the river leaving the patient’s arms exposed to the knee-deep water while he extracted himself from the vehicle.

     The patient initially did well postoperatively. By hospital day 8, he remained afebrile, but developed wound necrosis that required debridement in the operating room. Operative findings included two small purulent subcutaneous fluid collections in the wound.