Vascular Steal Syndrome and Shewanella alga Infection Requiring Amputation in a Hemodialysis Patient.

Shewanella alga is a rare gram-negative marine bacterium. Its role as a pathogenic organism is gradually evolving with sporadic cases being reported in humans. We report a case of vascular steal syndrome secondary to a polytetrafluoroethylene (PTFE) graft in the upper extremity of an end-stage renal disease (ESRD) patient on maintenance hemodialysis, which was complicated by infection with S. alga. This resulted in extensive myonecrosis requiring amputation of the limb. To our knowledge this is the fourth case of primary S. alga infection, and the first case in a hemodialysis patient reported in the medical literature from the United States. We also discuss the biochemical tests for identification and differentiation of S. alga from a closely related strain S. putrefaciens.