BACKGROUND
Vibrio vulnificus causes rapidly progressive soft‑tissue infection and sepsis, with high mortality in immunocompromised individuals, such as those with chronic liver disease. Delayed diagnosis is common when exposure history is inaccurate or concealed. This report describes a fatal case of V. vulnificus-induced necrotizing fasciitis and septic shock in a 72-year-old man with chronic alcohol use following a fish spine puncture wound of the right foot, initially diagnosed as snakebite.
CASE REPORT
A 72-year-old man with chronic alcohol use from Liuzhou, China, presented in August 2025 with right foot swelling and pain. On August 7 at 4 PM, he sustained a fish-associated puncture wound from a tilapia fin spine while cleaning fish; the wound was ignored. On August 8, swelling and pain developed, which he misattributed to an animal bite. He was admitted with suspected snakebite (22 h after injury); debridement with vacuum sealing drainage (VSD) was performed. On August 9 (40 h after injury), his condition deteriorated, and the true fish puncture history was obtained. He was transferred to the intensive care unit (ICU); antibiotics were escalated to vancomycin and meropenem. On August 10 (67 h after injury), wound and blood cultures confirmed V. vulnificus. Despite maximal support, refractory septic shock and multiple organ dysfunction syndrome (MODS) developed. Treatment was withdrawn, and he died on August 13.
CONCLUSIONS
In patients with rapidly progressive limb infection and sepsis following potential fish-related injuries, early clarification of exposure history and timely microbiological evaluation are critical, even when the fish is reportedly from a freshwater source.

Keywords: Vibrio vulnificus; Shock, Septic; Bacteremia; Case Reports; Fasciitis, Necrotizing