The patient’s examination is very troubling, with all four Kanavel signs for infectious flexor tenosynovitis: flexor-sheath tenderness, circumferential swelling (a “sausage digit”), pain with passive stretch, and flexed posture.
In cases involving seawater exposure with rapidly progressive infection or evidence of systemic involvement, vibrio species must be considered. Other waterborne infectious agents are much less likely to manifest the fulminant features that were seen in this case. Vibrio is a gram-negative rod that is typically found in warm saltwaters, although it has been isolated in waters as cold as 17°C.
V. vulnificus infections can rapidly become fatal, progressing from an initial presentation of cellulitis, tenosynovitis, or necrotizing fasciitis to septicemia and death within 48 to 72 hours.