Photobacterium damselae and Vibrio harveyi hand infection from marine exposure

75-year-old man presented to the emergency department at ur tertiary teaching hospital on 11 April 2014 with a 3-day history f a rapidly enlarging, painful haemorrhagic blister on his right and. He had caught sea bream while fishing at a southern ydney beach 3 days earlier, but did not recall any hand trauma. is past medical history was significant only for hypertension amlodipine 10 mg daily), hypercholesterolaemia (atorvastatin mg daily) and mild penicillin allergy. At presentation, he was brile (38.3 C), with a tense, tender, 3 3 cm haemorrhagic ullous lesion surrounded by erythema and swelling of the hand nd forearm with reduced range of wrist movement (Figure, A). ystemic examination was unremarkable. His white cell count as elevated (14.4 10/L; reference interval [RI], 3.5e11 10/ ) with neutrophilia (10.9 10/L; RI, 1.7e7 10/L), and his Cactive protein level was 30 mg/L (RI, < 3 mg/L). Fluid was septically aspirated from the lesion, inoculated into blood ulture bottles and incubated in the automated BacT/ALERT 3D ystem (bioM erieux). Treatment was commenced with oxycycline 100 mg orally 12-hourly and cefazolin 1 g travenously every 8 hours.