Fatal aeromonas hydrophila infection of soft tissue after endoscopic injection sclerotherapy for gastric variceal bleeding.

Aeromonas hydrophila, an anaerobic gram-negative bacillus, can cause severe infections in immune-compromised patients. We present a 45-year-old cirrhotic man who suffered from hematemesis and received emergency endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. Twenty-one hours after EIS, painful swelling of the bilateral lower extremities and fever occurred. Severe soft-tissue infections with emergence of hemorrhagic bullae over the bilateral lower extremities followed. Even under aggressive treatment, the patient died of overwhelming sepsis 42 hours after EIS. Cultures of the blood and serosanguineous fluid from the hemorrhagic bullae revealed Aeromonas hydrophila. To the best of our knowledge, this is the first case of fatal Aeromonas hydrophila infection after emergancy EIS for gastric variceal bleeding reported in the English literature. It is worth emphasizing that physicians should consider Aeromonas hydrophila infection in cirrhotic patients who develop soft-tissue infections after variceal bleeding whether emergency EIS has been performed or not.