A fatal case of necrotizing fasciitis by Aeromonas jandaei

Introduction: Necrotizing soft tissue infections are associated with an extremely fulminating course, owing to their rapid destruction of tissue planes underlying the skin. Aeromonas associated monomicrobial NSTIs are usually associated with exposure to fresh water, via trauma, trivial abrasions or even reptile bites, particularly among agricultural workers and fish handlers. Albeit uncommon in incidence, urgent medical and surgical intervention is required once diagnosis is reached. Case report : A 40-year-old male patient, known case of alcoholic liver disease, presented to the emergency department with pain and diffuse swelling of bilateral lower limbs, which quickly progressed to form blackish discolouration and blebs. Blood for preliminary haematological and biochemical investigations, as well as fluid draining from blebs were sent for microbiological investigation. The gram stain revealed occasional neutrophils and gram-negative bacilli, pure growth in aerobic culture was identified as Aeromonasjandaei by Matrix-assisted laser desorption/ionization Time of Flight Mass Spectrometry (MALDI-TOF MS). Patient was started on empirical antimicrobials, though lesions continued to progress and he ultimately succumbed within 12 hours of his hospital stay. Conclusion : As appropriate antimicrobial therapy and early surgical intervention are required for management of the same, occupational exposure and the fulminant course should raise suspicion of likelihood of Aeromonas associated infections.