Vibrio vulnificus tonsillitis after swimming in the Gulf of Mexico

Description

A 55-year-old man with decompensated cirrhosis secondary to Laennec's (alcoholic) cirrhosis and insulin-dependent diabetes mellitus presented with acute dysphagia and left-sided neck pain within hours of swimming in the Florida Gulf of Mexico. He did not ingest raw seafood, eat raw vegetables washed with fresh water or intentionally drink sea water prior to the presentation. He reported no gastrointestinal complaints. On examination, temperature was 39.1°C, and heart rate was 109 beats per minute with normal blood pressure. He appeared generally toxic and had an inflamed, ulcerated left tonsil; later, an axillary skin lesion developed with no trauma to the axillary area (figure 1). Neck CT showed submucosal tonsillar oedema, enlarged left palatine tonsil and reactive lymphadenopathy, consistent with acute tonsillitis (figure 2).

Figure 1

Tonsillar and pharyngeal lesions which appear ulcerated, inflamed and necrotic (A, B). Erythematous, slightly tender axillary lesion that appeared after the...

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