A 74-year-old man presented to the emergency department with a 3-day history of a painful laceration on his right leg that he had sustained while jumping into waters off the Gulf Coast of Florida. Two days after the injury to his leg, skin changes had appeared on his right arm. Physical examination is shown of the right lower leg and right forearm. He had no known history of chronic liver disease or an immunocompromising condition. Which of the following is the most likely diagnosis?
一名 74 岁男性因右腿疼痛性裂伤 3 天就诊于急诊科。受伤原因是他在佛罗里达海湾（Gulf Coast）跳入海水中时所致。腿部受伤两天后，其右臂皮肤出现病变。体格检查显示右小腿和右前臂存在相应皮损（如图所示）。患者无慢性肝病或免疫功能低下病史。以下哪项是最可能的诊断？
A. Aeromonas cellulitis气单胞菌蜂窝织炎
B. Clostridium perfringens gas gangrene产气荚膜梭菌气性坏疽
C. Pseudomonas aeruginosa cellulitis铜绿假单胞菌蜂窝织炎
D. Mycobacterium marinum skin and soft tissue infection海分枝杆菌皮肤和软组织感染
E. Vibrio vulnificus skin and soft-tissue infection创伤弧菌皮肤和软组织感染
答案解析：
最终确诊为创伤弧菌（Vibrio vulnificus）坏死性软组织感染。创伤弧菌常见于温暖的低盐度沿海及河口水域。其主要传播途径为食用未煮熟的海鲜，或开放性伤口暴露于含有该菌的水体中。受气候变化相关因素影响，预计创伤弧菌的数量及其地理分布范围将有所扩大，这些因素包括水温升高、风暴潮、盐度变化以及藻类大量繁殖。该患者接受了截肢手术并进行了抗生素治疗。
正确答案：E
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