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Title : A 49 year-old male with painful swelling in left lower leg
Date : Sep.1, 2010
Contributed by

Wi Yu Mi Md

Samsung Changwon Hospital, Korea

Patient History
Age/Sex A 49 year-old male
Chief complaint Painful swelling in left lower leg
Present illness

A 49 year-old male presented with fever and painful swelling in his left lower leg. One month earlier, the patient had injured his leg on a wooden bar. He then went fishing in the southern sea of Korea. Ten days before admission, he returned home and he became febrile and started to feel left lower leg pain. Because there was no improvement after 7 days of antibiotics and antipyretics, he was referred to our hospital.

Past medical history

Gout since 4 years ago

Heavy alcoholics

Physical examination

Left lower leg was erythematous and edematous.

External wound was noted on the anterior aspect of left lower leg.  

Initial laboratory findings

White blood cell count, 3,3400/μL; hemoglobin, 11.9 g/μL; platelet count, 136,000/μL; prothrombin time, 12.2 sec with an INR of 0.96; partial thromboplastin time, 23.3 sec; total serum protein, 4.9 g/dL; albumin, 1.5 g/dL; aspartate aminotransferase, 72 U/L; alanine aminotransferase, 58 U/L; alkaline phosphatase, 170 U/L; total bilirubin, 2.3 mg/dL; blood urea nitrogen, 38.8 mg/dL; creatinine, 1.7 mg/dL; creatinine kinase, 199 U/L; lactate dehydrogenase 351 U/L; and C-reactive protein, 322.14 mg/dL.

Radiologic findings

Multiloculated cystic lesions or ill-defined high signal intensity at left vastus muscles, iliopsoas muscle(distal portion), sarttorius muscle and gluteal muscles, pectineus muscle, obturator externus muscle and adductor muscles areas, on T2WI MRI


 
Question - ID Case of the Week ( Sep.1, 2010 )
What do you think the most likely diagnosis is ?
 
Correct Answer

Shewanella algae myofasciitis

 
Review

 

Among the marine-acquired infections, the epidemiology of S. algae infections is similar to infections involving marine bacteria, such as Vibrio and Aeromonas. S. algae can be isolated from seawater with water temperatures > 13 °C during summer season. The most commonly described Shewanella infections involve the ears, skin, and soft tissues, with or without bacteremia. Three syndromes of bacteremia with Shewanella spp. appear to exist as infections associated with the following clinical conditions: 1) prematurity and congenital pneumonia, 2) ulcerations of the lower extremities, and 3) an underlying disability, such as hepatobiliary disease or malignancy. The combination of piperacillin with amikacin or gentamicin is recommended in antimicrobial treatment of Shewanella infection.

 


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