Rhabdomyolysis and Aeromonas infection after environmental exposure.

The patient is a 37-year-old man who was brought to the emergency department by the Coast Guard after he was rescued from a swamp. He was hunting when he became lost and separated from his group. When brought into the emergency department, he had been missing for 36 hours and had drunk only swamp water. he reported losing his shoes and socks in the mud as well as ripping off his pants on brush. Upon arrival, his vitals were T 93.4 F (oral), P 103, RR 24, BP 107/79. The physical exam was remarkable for a well-nourished, well-developed man covered in mud from head to toe with excoriations, lacerations, and severe pain of both lower extremities. Labs were as follows: WBC 27.6 with 8% bands, creatinine of 6.3 and anion gap of 30; urine drug screen: positive for marijuana and amphetamines; CPK 31,445 and myoglobin 175,234. Multiple pustules on bilayer lower extremities developed within 24 hours. Blood and wound cultures grew Aeromonas hydrophila. Environmental exposure presents clinicians with unusual problems. Dehydration, rhabdomyolysis, and infection are life-threatening conditions that must be detected and treated early on. In this case, the rhabdomyolysis was not unexpected, but infection with Aeromonas, which is usually found in burn patients, was an intriguing discovery. The patient was in the hospital for approximately 2 weeks, in which time he made a full recovery.

Alaina Amato, MD. Internal Medicine Department, University of South Alabama Medical Center, Mobile, AL.