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Presentation

A 67-year-old male came to the emergency department with redness, swelling and pain in his left lower leg. He admitted having a fever and chills prior to arriving, and that the previous day he had fallen and injured his left leg on a crab basket. Labs showed a high white blood cell count with the likely presence of inflammation. CT imaging revealed edema with no abscess or soft tissue gas. Blood cultures were sent for testing and the patient started on empiric antibiotics doxycycline and ceftriaxone.

After incubation for 18 hours, the aerobic culture signaled positive for organism growth, and a Gram stain revealed curved, gram-negative rods. A multiplex PCR used for rapid organism identification in blood cultures was negative for the potential pathogens included in the PCR panel. Colonies grew on plate media and demonstrated positive indole and oxidase tests, while the patient began to have newly developed bullae with their wound.

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Author Information

Tyler Cox, D.O., Pathology Resident, Virginia Commonwealth University Health Systems.