Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 13064-13073
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13064
Successful surgical treatment of polybacterial gas gangrene confirmed by metagenomic next-generation sequencing detection: A case report
Hong-Yan Lu, Yan-Bin Gao, Xue-Wen Qiu, Qi Wang, Chen-Mei Liu, Xiao-Wen Huang, Hong-Yu Chen, Kang Zeng, Chang-Xing Li
Hong-Yan Lu, Qi Wang, Chen-Mei Liu, Xiao-Wen Huang, Hong-Yu Chen, Kang Zeng, Chang-Xing Li, Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Yan-Bin Gao, Xue-Wen Qiu, Department of Burns Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Lu HY performed sequencing and was a major contributor in writing the manuscript; Gao YB and Qiu XW performed the surgery; Wang Q and Huang XW provided samples, clinical data, contributed to project design and operation, data interpretation, and manuscript preparation; Liu CM and Chen HY contributed to project design and operation; Li CX and Zeng K contributed to project design and operation, data interpretation, and was a major contributor in writing the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82173437; and Natural Science Foundation of Guangdong Province, No. 2020A15150875.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Xing Li, PhD, Professor, Department of Dermatology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong Province, China. lilichangxing@163.com
Received: September 7, 2022
Peer-review started: September 7, 2022
First decision: September 27, 2022
Revised: October 2, 2022
Accepted: November 17, 2022
Article in press: November 17, 2022
Published online: December 16, 2022
Processing time: 97 Days and 22.7 Hours
Abstract
BACKGROUND

We report on a case of Vibrio vulnificus (V. vulnificus) detected by metagenomics next-generation sequencing (mNGS) in a 53-year-old male patient with polymicrobial gas gangrene and successful treatment by surgery. This report raises awareness among dermatologists that when a patient is clinically suspected of a special type of pathogenic infection, the mNGS method should be preferred to identify the patient’s pathogen infection as soon as possible and then take effective treatment in time to save patients’ lives.

CASE SUMMARY

A 53-year-old male who worked in the aquatic market complained of redness and swelling of the lower limbs, blisters and ulcers with fever for 3 d. We used mNGS to test the pathogens in ulcer secretions. The results were returned in 24 h and indicated: V. vulnificus, Fusobacterium necrophorum, Staphylococcus haemolyticus, Staphylococcus aureus, Streptococcus dysgalactiae and Klebsiella aerogenes. This patient was diagnosed with V. vulnificus infection. The emergency operation was performed immediately under combined lumbar and epidural anesthesia: Left leg expansion and exploration (August 10, 2021). After surgery, we continued to use piperacillin sodium tazobactam sodium 4.5 g every 8 h and levofloxacin 0.5 g for anti-infection treatment. The patient underwent further surgery under lumbar anesthesia on August 17, 2021 and August 31, 2021: Left leg deactivation and skin grafting, negative pressure closed drainage and right thigh skin removal. After treatment, the transplanted flap survived.

CONCLUSION

We could confirm the diagnosis of Vibrio vulnificus infection within 24 h through mNGS detection and then immediately performed emergency surgery.

Keywords: Metagenomics next-generation sequencing; Vibrio vulnificus; Polymicrobial gas gangrene; Surgery; Case report

Core Tip: We report on a case of Vibrio vulnificus detected by metagenomic next-generation sequencing (mNGS) in a 53-year-old male patient with polymicrobial gas gangrene and successful treatment by surgery. This report raises awareness among dermatologists that when a patient is clinically suspected of a special type of pathogenic infection, the mNGS method should be preferred to identify the patient’s pathogen infection as soon as possible, and then take effective treatment in time to save patients’ lives.