Case: A 9-year-old boy suffered incidental trauma to the anterolateral leg from the barb of a freshwater fish. Within a few days of injury, the patient developed a fever and a deep abscess despite empiric antibiotic therapy. The underlying pathogen was Edwardsiella tarda. This study is the first report of such an abscess in a child, and similar reported cases have in adults have been associated with high rates of mortality.
Conclusion: Penetrating soft-tissue trauma in association with an aquatic environment requires prompt evaluation. Empiric antibiotic regimens effective against terrestrial cellulitis may lack adequate gram-negative coverage for aquatically related injuries.