Case Report: From trivial trauma to fulminant septic shock: multidisciplinary rescue of Vibrio vulnificus necrotizing fasciitis via a seven-stage surgical protocol with limb salvage

TL;DR

A seafood vendor survived a severe Vibrio vulnificus infection after minor trauma, highlighting the need for early treatment and public health monitoring.

Contribution

Demonstrates prolonged incubation of V. vulnificus due to cold-chain disruption and successful multidisciplinary treatment.

Findings

Vibrio vulnificus was identified through wound culture and metagenomic sequencing.

Seven-stage surgical interventions and early antibiotics led to successful recovery.

Cold-chain disruption can extend the incubation period to 7 days, challenging traditional epidemiology.

Abstract

To report a successful case of an inland seafood vendor who developed Vibrio vulnificus necrotizing fasciitis complicated by septic shock following a minor calf abrasion, and to explore its special epidemiological implications and key points for standardized management.

A 46-year-old male seafood vendor (hospitalized from July 3 to 10 August 2025) presented on post-injury day 7 with fulminant necrotizing fasciitis, septic shock, and multiple organ dysfunction syndrome. Vibrio vulnificus was identified by wound culture and metagenomic sequencing. Management included early combination antibiotics, ICU organ support, and seven sequential surgical interventions. The patient was successfully weaned from mechanical ventilation and extubated after 25 days of ICU care, and discharged on hospital day 30 with satisfactory wound healing.

This case alerts that high inoculum exposure due to cold-chain disruption can prolong the incubation period of V. vulnificus infection to 7 days, transcending traditional epidemiological boundaries. Successful management depended on early fasciotomy and strict adherence to standardized treatment protocols. Mandatory wound monitoring for high-risk occupational populations should become a new priority in public health prevention and control.

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