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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 8 | 20 |
| 2024 Octubre | 95 | 42 | 137 |
| 2024 Septiembre | 86 | 30 | 116 |
| 2024 Agosto | 120 | 61 | 181 |
| 2024 Julio | 79 | 41 | 120 |
| 2024 Junio | 90 | 36 | 126 |
| 2024 Mayo | 98 | 37 | 135 |
| 2024 Abril | 59 | 20 | 79 |
| 2024 Marzo | 86 | 24 | 110 |
| 2024 Febrero | 54 | 34 | 88 |
| 2024 Enero | 66 | 41 | 107 |
| 2023 Diciembre | 68 | 19 | 87 |
| 2023 Noviembre | 99 | 28 | 127 |
| 2023 Octubre | 108 | 25 | 133 |
| 2023 Septiembre | 118 | 34 | 152 |
| 2023 Agosto | 68 | 15 | 83 |
| 2023 Julio | 69 | 44 | 113 |
| 2023 Junio | 78 | 37 | 115 |
| 2023 Mayo | 76 | 26 | 102 |
| 2023 Abril | 77 | 28 | 105 |
| 2023 Marzo | 63 | 20 | 83 |
| 2023 Febrero | 67 | 28 | 95 |
| 2023 Enero | 47 | 24 | 71 |
| 2022 Diciembre | 62 | 38 | 100 |
| 2022 Noviembre | 34 | 32 | 66 |
| 2022 Octubre | 30 | 34 | 64 |
| 2022 Septiembre | 26 | 52 | 78 |
| 2022 Agosto | 29 | 43 | 72 |
| 2022 Julio | 26 | 33 | 59 |
| 2022 Junio | 24 | 25 | 49 |
| 2022 Mayo | 47 | 41 | 88 |
| 2022 Abril | 57 | 30 | 87 |
| 2022 Marzo | 47 | 56 | 103 |
| 2022 Febrero | 54 | 37 | 91 |
| 2022 Enero | 86 | 40 | 126 |
| 2021 Diciembre | 43 | 43 | 86 |
| 2021 Noviembre | 62 | 45 | 107 |
| 2021 Octubre | 45 | 37 | 82 |
| 2021 Septiembre | 47 | 37 | 84 |
| 2021 Agosto | 80 | 23 | 103 |
| 2021 Julio | 51 | 26 | 77 |
| 2021 Junio | 40 | 18 | 58 |
| 2021 Mayo | 33 | 24 | 57 |
| 2021 Abril | 64 | 23 | 87 |
| 2021 Marzo | 42 | 23 | 65 |
| 2021 Febrero | 47 | 24 | 71 |
| 2021 Enero | 21 | 18 | 39 |
| 2020 Diciembre | 9 | 18 | 27 |
| 2020 Noviembre | 25 | 20 | 45 |
| 2020 Octubre | 19 | 14 | 33 |
| 2020 Septiembre | 33 | 7 | 40 |
| 2020 Agosto | 33 | 28 | 61 |
| 2020 Julio | 39 | 9 | 48 |
| 2020 Junio | 34 | 26 | 60 |
| 2020 Mayo | 23 | 14 | 37 |
| 2020 Abril | 34 | 20 | 54 |
| 2020 Marzo | 29 | 15 | 44 |
| 2020 Febrero | 7 | 0 | 7 |
| 2020 Enero | 4 | 1 | 5 |
| 2019 Diciembre | 8 | 3 | 11 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Septiembre | 4 | 6 | 10 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 13 | 17 |
| 2019 Junio | 4 | 19 | 23 |
| 2019 Mayo | 6 | 35 | 41 |
| 2019 Abril | 3 | 8 | 11 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 2 | 3 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 14 | 0 | 14 |
| 2018 Mayo | 0 | 1 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 24 | 4 | 28 |
| 2018 Enero | 30 | 5 | 35 |
| 2017 Diciembre | 36 | 12 | 48 |
| 2017 Noviembre | 26 | 5 | 31 |
| 2017 Octubre | 26 | 8 | 34 |
| 2017 Septiembre | 27 | 7 | 34 |
| 2017 Agosto | 27 | 4 | 31 |
| 2017 Julio | 23 | 13 | 36 |
| 2017 Junio | 32 | 15 | 47 |
| 2017 Mayo | 38 | 17 | 55 |
| 2017 Abril | 24 | 7 | 31 |
| 2017 Marzo | 10 | 32 | 42 |
| 2017 Febrero | 16 | 10 | 26 |
| 2017 Enero | 19 | 19 | 38 |
| 2016 Diciembre | 19 | 24 | 43 |
| 2016 Noviembre | 27 | 34 | 61 |
| 2016 Octubre | 22 | 29 | 51 |
| 2016 Septiembre | 0 | 2 | 2 |
| 2016 Junio | 1 | 12 | 13 |
| 2016 Mayo | 1 | 5 | 6 |
| 2016 Abril | 0 | 3 | 3 |
| 2016 Marzo | 0 | 1 | 1 |
| 2016 Febrero | 0 | 2 | 2 |
| 2016 Enero | 0 | 1 | 1 |
| 2015 Diciembre | 0 | 1 | 1 |
| 2015 Noviembre | 0 | 2 | 2 |
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