Disclosures: Marla A. Petriello, DO: No financial relationships or conflicts of interest

Case Description: The patient initially presented to the acute care hospital with nausea, bloating, and severe abdominal pain. A few days prior to presentation, he had consumed raw oysters from the Virginia Beach region. He was found to be in septic shock requiring intubation, vasopressor use, and prolonged ICU admission. The bacterial source was identified as vibrio vulnificus. While in the ICU, the patient developed vasopressor induced limb ischemia, requiring bilateral below the knee amputations, as well as multiple ischemic digits. Once stabilized, he was transferred to the acute inpatient rehabilitation hospital.

Setting: Acute inpatient rehabilitation hospital

Patient: 54 year old male with history of ankylosing spondylitis on chronic immunosuppressive therapy Assessment/

Results: Prior to admission to the hospital, the patient had previously consumed raw oysters from the Virginia Beach region at dinner one night. He subsequently developed acute abdominal pain and presented to the emergency room where he was found to be in septic shock. The source was identified as vibrio vulnificus. He required prolonged vasopressor therapy leading to necrosis of all four limbs and requiring bilateral below the knee amputations.

Discussion: Vibrio vulnificus is a naturally occurring bacteria in the Chesapeake Bay region. As water temperatures increase in the setting of global warming, the percentage of oysters carrying vibrio is increasing. Vibrio bacteria thrive in warmer water conditions, and from 1980-2010 the Chesapeake Bay region water temperature has been reported to have increased by 2.52 degrees Fahrenheit. Vibrio vulnificus infections in an immunocompetent host will usually lead to general abdominal symptoms. However, in immunocompromised individuals, a much more severe illness can occur leading to sepsis, as shown in this case.

Conclusion: As we see an increase in the water temperatures in the Chesapeake Bay region, it is important to remember the risks of eating raw seafood, especially for the immunocompromised host.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/chesapeake-bay-oyster-causing-vibrio-septic-shock-and-vasopressor-induced-quadrilateral-limb-ischemia-in-an-immunosuppressed-individual-a-case-report/