Case and Research Letters
Cutaneous Ulcer at the Site of Radiation-Induced Dermatitis Caused by Infection With Vibrio alginolyticus
Úlcera cutánea sobre radiodermitis crónica por Vibrio alginolyticus
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A, The ossifying fibromyxoid tumor with its characteristic, incomplete capsule of lamellar bone; hematoxylin and eosin (H&E), original magnification ×<span class="elsevierStyleHsp" style=""></span>2. B, Monomorphic epithelioid cells with small nucleoli and clearly distinct borders; H&E, original magnification ×<span class="elsevierStyleHsp" style=""></span>40.<span class="elsevierStyleHsp" style=""></span>C, Immunohistochemistry showing diffuse positivity for protein S-100; original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Hernández-Godoy, C. Casado-Sánchez, L. Landín, A.A. Rosell" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Hernández-Godoy" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Casado-Sánchez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Landín" ] 3 => array:2 [ "nombre" => "A.A." 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Escudero, L.J. del Pozo, E. Jubert, M. Riera" "autores" => array:4 [ 0 => array:3 [ "nombre" => "M.M." "apellidos" => "Escudero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "L.J." "apellidos" => "del Pozo" "email" => array:1 [ 0 => "lpozoh@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Jubert" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Riera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitari Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlcera cutánea sobre radiodermitis crónica por <span class="elsevierStyleItalic">Vibrio alginolyticus</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 525 "Ancho" => 946 "Tamanyo" => 79995 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A Growth of colonies of <span class="elsevierStyleItalic">Vibrio alginolyticus</span> in blood agar. B, Cutaneous ulcer on the sole of the left foot on an area of chronic radiation-induced dermatitis. Note the formation of an abscess.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 66-year-old man with a painful ulcer that he first noticed on the sole of his left foot 2 months previously. The lesion appeared during the month of August on atrophic and scarred skin that was compatible with chronic radiation-induced dermatitis over an area where 15 years earlier he had received radiation therapy for a skin lesion of unknown origin (no medical or histological data were available). The patient lived on the island of Mallorca and habitually walked along the seashore. He reported no history of diabetes, hypertension, smoking, or other systemic symptoms or conditions of interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Examination of the skin revealed an ulcer with yellowish exudate, indurated margins, and atrophic skin in the adjacent areas. A blood workup revealed no leukocytosis or increased C-reactive protein levels. A substantial amount of tissue was taken from the margin and base of the ulcer for biopsy. Histopathology revealed collagenic fibrosis in the dermis and signs of vascular disease but no cellular atypia. These findings were compatible with radiation-induced dermatitis. Neoplastic processes were ruled out. Culture of the exudate revealed <span class="elsevierStyleItalic">Vibrio alginolyticus</span> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Based on the results of the antibiogram, treatment was started with oral ciprofloxacin. However, the course was indolent, with the formation of a skin abscess (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) and development of osteomyelitis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) requiring admission to hospital. The lesion was debrided, even though no microorganisms grew in the culture. Antibiotic therapy was started with doxycycline and ceftriaxone for 10 days. Progress was good, and the ulcer resolved after 3 months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">V alginolyticus</span> is a Gram-negative rod belonging to the genus <span class="elsevierStyleItalic">Vibrio</span>. It is the most halophilic of the <span class="elsevierStyleItalic">Vibrio</span> species, since it can grow in salt concentrations as high as 10%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">V alginolyticus</span> is pathogenic for humans, although its virulence is low, and it is acquired after exposure to seawater or marine animals. <span class="elsevierStyleItalic">V alginolyticus</span> was the only microorganism isolated in the present case. However, it is often found in association with other <span class="elsevierStyleItalic">Vibrio</span> species such as <span class="elsevierStyleItalic">Vibrio parahaemolyticus</span> or <span class="elsevierStyleItalic">Vibrio vulnificus</span>.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">V alginolyticus</span> forms part of the habitual marine flora in temperate and tropical coastal waters. The incidence of infection by this microorganism in humans increases significantly during summer owing to the increase in the temperature of seawater.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Similarly, the climate change observed in recent years leads us to believe that the density of this bacteria has been increasing both in tropical waters and in the colder waters of northern Europe.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The microorganism is mainly associated with conjunctivitis, otitis, gastroenteritis, and superinfection of wounds that come into contact with contaminated seawater.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Although its course is usually benign and it responds well to oral antibiotic therapy, cases of bacteremia and necrotizing fasciitis have also been reported.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Patients usually present some degree of immunosuppression (eg, advanced age, diabetes mellitus, liver disease, or immunosuppressive therapy) that predisposes them to infection.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our literature search yielded only 1 other case of osteomyelitis caused by <span class="elsevierStyleItalic">V alginolyticus</span>. The patient had chronic hepatitis C and a surgical wound that became superinfected after exposure to seawater and progressed to involve bone tissue. As in the case we report, the patient's condition resolved with extensive surgical debridement and intravenous antibiotic therapy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ulcers appearing on areas of radiation-induced dermatitis are particularly difficult to manage. Clinically, the skin is atrophic, sclerosed, and lacking adnexa, with altered pigment and telangiectases. Lesions on areas of chronic radiation-induced dermatitis appear at least 2 years after administration of ionizing radiation. The risk of secondary ulcers and cutaneous carcinoma is as high as 20%, since the skin is very deteriorated and chronically inflamed with a limited blood supply. Ulcers resulting from radiation-induced dermatitis usually have irregular margins and a base covered by very adherent yellowish slough. The indurated base of these lesions can lead us to suspect carcinoma. Hypoxia-induced tissue alterations and loss of skin integrity favor the risk of superinfection by various microorganisms.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In the case we present, the dermatitis lesions remaining after treatment received several years previously are in themselves a predisposing factor and a source of local immunosuppression, thus potentially explaining the poor initial outcome of the ulcer.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, this emerging microorganism should be taken into account in patients with infections of the skin and soft tissue who have been in contact with seawater or marine animals.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Escudero MM, del Pozo LJ, Jubert E, Riera M. Úlcera cutánea sobre radiodermitis crónica por <span class="elsevierStyleItalic">Vibrio alginolyticus</span>. Actas Dermosifiliogr. 2015;106:774–775.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 525 "Ancho" => 946 "Tamanyo" => 79995 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A Growth of colonies of <span class="elsevierStyleItalic">Vibrio alginolyticus</span> in blood agar. B, Cutaneous ulcer on the sole of the left foot on an area of chronic radiation-induced dermatitis. Note the formation of an abscess.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 735 "Ancho" => 951 "Tamanyo" => 56958 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Osteolysis of the heads of the third and fourth metatarsals.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diseases of humans (other than cholera) caused by vibrios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.A. Blake" 1 => "R.E. Weaver" 2 => "D.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 95 | 42 | 137 |
| 2024 September | 86 | 30 | 116 |
| 2024 August | 120 | 61 | 181 |
| 2024 July | 79 | 41 | 120 |
| 2024 June | 90 | 36 | 126 |
| 2024 May | 98 | 37 | 135 |
| 2024 April | 59 | 20 | 79 |
| 2024 March | 86 | 24 | 110 |
| 2024 February | 54 | 34 | 88 |
| 2024 January | 66 | 41 | 107 |
| 2023 December | 68 | 19 | 87 |
| 2023 November | 99 | 28 | 127 |
| 2023 October | 108 | 25 | 133 |
| 2023 September | 118 | 34 | 152 |
| 2023 August | 68 | 15 | 83 |
| 2023 July | 69 | 44 | 113 |
| 2023 June | 78 | 37 | 115 |
| 2023 May | 76 | 26 | 102 |
| 2023 April | 77 | 28 | 105 |
| 2023 March | 63 | 20 | 83 |
| 2023 February | 67 | 28 | 95 |
| 2023 January | 47 | 24 | 71 |
| 2022 December | 62 | 38 | 100 |
| 2022 November | 34 | 32 | 66 |
| 2022 October | 30 | 34 | 64 |
| 2022 September | 26 | 52 | 78 |
| 2022 August | 29 | 43 | 72 |
| 2022 July | 26 | 33 | 59 |
| 2022 June | 24 | 25 | 49 |
| 2022 May | 47 | 41 | 88 |
| 2022 April | 57 | 30 | 87 |
| 2022 March | 47 | 56 | 103 |
| 2022 February | 54 | 37 | 91 |
| 2022 January | 86 | 40 | 126 |
| 2021 December | 43 | 43 | 86 |
| 2021 November | 62 | 45 | 107 |
| 2021 October | 45 | 37 | 82 |
| 2021 September | 47 | 37 | 84 |
| 2021 August | 80 | 23 | 103 |
| 2021 July | 51 | 26 | 77 |
| 2021 June | 40 | 18 | 58 |
| 2021 May | 33 | 24 | 57 |
| 2021 April | 64 | 23 | 87 |
| 2021 March | 42 | 23 | 65 |
| 2021 February | 47 | 24 | 71 |
| 2021 January | 21 | 18 | 39 |
| 2020 December | 9 | 18 | 27 |
| 2020 November | 25 | 20 | 45 |
| 2020 October | 19 | 14 | 33 |
| 2020 September | 33 | 7 | 40 |
| 2020 August | 33 | 28 | 61 |
| 2020 July | 39 | 9 | 48 |
| 2020 June | 34 | 26 | 60 |
| 2020 May | 23 | 14 | 37 |
| 2020 April | 34 | 20 | 54 |
| 2020 March | 29 | 15 | 44 |
| 2020 February | 7 | 0 | 7 |
| 2020 January | 4 | 1 | 5 |
| 2019 December | 8 | 3 | 11 |
| 2019 November | 4 | 2 | 6 |
| 2019 September | 4 | 6 | 10 |
| 2019 August | 4 | 7 | 11 |
| 2019 July | 4 | 13 | 17 |
| 2019 June | 4 | 19 | 23 |
| 2019 May | 6 | 35 | 41 |
| 2019 April | 3 | 8 | 11 |
| 2019 March | 2 | 6 | 8 |
| 2019 February | 2 | 3 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 14 | 0 | 14 |
| 2018 May | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
| 2018 February | 24 | 4 | 28 |
| 2018 January | 30 | 5 | 35 |
| 2017 December | 36 | 12 | 48 |
| 2017 November | 26 | 5 | 31 |
| 2017 October | 26 | 8 | 34 |
| 2017 September | 27 | 7 | 34 |
| 2017 August | 27 | 4 | 31 |
| 2017 July | 23 | 13 | 36 |
| 2017 June | 32 | 15 | 47 |
| 2017 May | 38 | 17 | 55 |
| 2017 April | 24 | 7 | 31 |
| 2017 March | 10 | 32 | 42 |
| 2017 February | 16 | 10 | 26 |
| 2017 January | 19 | 19 | 38 |
| 2016 December | 19 | 24 | 43 |
| 2016 November | 27 | 34 | 61 |
| 2016 October | 22 | 29 | 51 |
| 2016 September | 0 | 2 | 2 |
| 2016 June | 1 | 12 | 13 |
| 2016 May | 1 | 5 | 6 |
| 2016 April | 0 | 3 | 3 |
| 2016 March | 0 | 1 | 1 |
| 2016 February | 0 | 2 | 2 |
| 2016 January | 0 | 1 | 1 |
| 2015 December | 0 | 1 | 1 |
| 2015 November | 0 | 2 | 2 |
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