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Hemorrhagic bullae in an ill-appearing patient with underlying cirrhosis should prompt consideration for an invasive infection due to Vibrio vulnificus.
V. Vulnificus is a gram negative rod and causes a highly lethal infection in patients with cirrhosis.
Antibiotics for these patients should include coverage for this organism. This should include doxycycline and a third genaration cephalosporin.
References
1. Evidence-Based Medicine: 500 Clues to Diagnosis and Treatment, Ellerin and Diaz
2. CDC