Ling Yang,1 Zhiwen Zhang,2 Qing Liang,2 Hao Zhang,1 Yijin Wang,1 Chao Zhuo1 

1Department of Infection Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 2Emergency Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China

Correspondence: Chao Zhuo, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China, Tel +8618928868397, Email chaosheep@gzhmu.edu.cn

Abstract: This study presents a rare case of severe acute bacterial skin and soft tissue infection (ABSSSI) following freshwater fish spike injury in a 73-year-old man. Within 24 hours of sustaining the wound, the patient developed septic shock and progressive necrotizing fasciitis. Despite early administration of broad-spectrum antibiotics and intensive care, his condition deteriorated, necessitating below-the-elbow amputation on hospital day four. Metagenomic next-generation sequencing (mNGS) identified Aeromonas veronii as the causative agent. Although the patient showed temporary improvement postoperatively, he later developed hospital-acquired pneumonia and succumbed to complications two months later. This case highlights the potential severity of ABSSSIs caused by aquatic pathogens, particularly in immunocompromised individuals. mNGS provides a comprehensive pathogen snapshot within hours of sample receipt, enabling timely refinement of empiric regimens prior to antimicrobial susceptibility testing availability. Early surgical intervention is essential to control infections and improve clinical outcomes.

Keywords: acute bacterial skin and soft tissue infection, necrotizing fasciitis, fish-related human infection, Aeromonas veronii