Forearm necrotizing fasciitis caused by freshwater fish in an immunocompromised patient with rheumatoid arthritis for 20 years: a case report and review of the literature

Zhengnan Zhao; Peng Wang; Lei Ma; Yang Wang; Jiaping Guo; Chenglong  Yao; Zefan  Sun; Xiu Wang; Jiabao Yang

doi:10.71321/t6symt70

Authors

Zhengnan Zhao The Affiliated Suqian First People's Hospital of Nanjing Medical University
Peng Wang The Affiliated Suqian First People's Hospital of Nanjing Medical University
Lei Ma The Affiliated Suqian First People's Hospital of Nanjing Medical University
Yang Wang Department of Burn and Plastic Surgery, Jiangsu Province (Suqian) Hospital, Suqian, China
Jiaping Guo Department of Burn and Plastic Surgery, Jiangsu Province (Suqian) Hospital, Suqian, China
Chenglong Yao Department of Burn and Plastic Surgery, Jiangsu Province (Suqian) Hospital, Suqian, China
Zefan Sun Department of Burn and Plastic Surgery, Jiangsu Province (Suqian) Hospital, Suqian, China
Xiu Wang Department of Burn and Plastic Surgery, Jiangsu Province (Suqian) Hospital, Suqian, China
Jiabao Yang The Affiliated Suqian First People's Hospital of Nanjing Medical University

DOI:

https://doi.org/10.71321/t6symt70

Keywords:

Necrotizing fasciitis, Aeromonas sobria, Immunocompromised host, Septic shock

Abstract

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection typically associated with marine pathogens such as Vibrio vulnificus in cases involving fish-related injuries. This case report describes a rare instance of NF caused by Aeromonas sobria following a freshwater fish (Chinese carp) injury in a 58-year-old immunocompromised woman with a 20-year history of rheumatoid arthritis on long-term immunosuppressive therapy. The patient presented with rapid-onset swelling, pain, and septic shock, requiring intensive care, vasopressor support, and four surgical debridements with negative pressure wound therapy. Wound cultures confirmed Aeromonas sobria, contrasting with the more common marine-acquired Vibrio infections. Despite delayed diagnosis, aggressive multimodal management—including broad-spectrum antibiotics (piperacillin-tazobactam followed by meropenem) and repeated surgical interventions—resulted in survival after 41 days of hospitalization. This case highlights the importance of considering freshwater pathogens in NF, particularly in immunocompromised patients, and underscores the critical role of early surgical debridement and empiric antimicrobial coverage for atypical organisms. Clinicians should maintain a high suspicion for NF in fish-related injuries, even without marine exposure, to prevent fatal outcomes.

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