A Case of Necrotising Soft-tissue Infection and Sepsis Caused by Shewanella haliotis

Shewanella haliotis is an aquatic gram-negative rod, recently isolated from the gut microflora of abalone ( Haliotis discus hannai ) in 2007. Human disease caused by this species is extremely rare. We report the case of a 66-year-old man undergoing hemodialysis who was admitted for necrotizing soft-tissue infection on the left hand with sepsis. He had a history of liver cirrhosis and colon cancer. Clinical findings showed swollen erythema with purpura and bullae on his left hand. Gram-negative rods were detected in the blood culture. The colonies grew on the Thiosulfate Citrate Bile Salts Sucrose medium (TCBS), and produced H 2 S on the Triple Sugar Iron (TSI) agar. The pathological features presented hemorrhagic necrosis with an infiltration of neutrophils and lymphocytes in the subcutaneous tissue. S. haliotis was identified by 16S rRNA sequence analysis, nevertheless automated identification in the hospital showed Shewanella algae . Ceftazidime and isepamicin administration for 1 week and cefozopran and isepamicin administration for 1 week followed by oral levofloxacin for 1 week cured the sepsis, and furthermore, topical ointment completely cured the skin ulcer over 2.5 months. We should be aware that human infection caused by S. haliotis can result in severe necrotising soft-tissue infection with sepsis.