American Board of Internal Medicine (ABIM) Certification Practice Exam

What specific clinical feature is a hallmark of cellulitis caused by Vibrio vulnificus?

1. Pustular lesions

2. Hemorrhagic bullae

3. Ulcerative lesions

4. Necrotizing fasciitis

The correct answer is: Hemorrhagic bullae

When it comes to cellulitis caused by Vibrio vulnificus, the presence of hemorrhagic bullae is a key clinical feature. Vibrio vulnificus is a halophilic bacterium often associated with wound infections and seafood consumption, particularly in individuals with compromised immune systems or liver disease. The hallmark of infections caused by this organism is the development of hemorrhagic bullae, which are fluid-filled sacs that can appear bruised or filled with blood. These bullae usually arise following initial erythema and edema in the infected area, providing a significant clue as to the underlying infection. This feature is clinically significant as it indicates a more severe soft tissue infection compared to other pathogens that may cause cellulitis. Early recognition of this manifestation is crucial for timely and appropriate management, given Vibrio vulnificus's potential to lead to serious complications. Recognizing this clinical presentation can help differentiate infections by Vibrio vulnificus from those caused by other bacteria, which might not produce hemorrhagic bullae.