Emerging liver infection of Veillonella parvula associated with acute respiratory distress syndrome: a case report

Abstract

Introduction: Veillonella parvula is a bacteria that can be found in normal oral and gastrointestinal flora. Veillonella infection is rare in immunocompetent patients but is known to cause periorbital cellulitis, endocarditis, osteomyelitis and bacteremia; however, its association with acute respiratory distress syndrome (ARDS) has not been previously documented. Case presentation: A 36-year-old female with no known history who presented with right-sided chest, flank and upper abdominal pain after a motor vehicle accident. Computed tomography showed multiple right rib fractures, small right pneumothorax, and a grade 4 liver laceration with active extravasation of the posterior aspect of the right liver lobe. Over the hospital course, the patient developed ARDS and was intubated for hypoxemia. A right posterior liver abscess was percutaneously drained, with a copious amount of air and ~30 ml turbid fluid aspirated. Cultures from the liver abscess grew Veillonella parvula. She was treated with Micafungin, Levofloxacin, and Metronidazole for the hepatic abscess, and was discharged home with outpatient follow-up. Discussion: The authors present one of the first reported cases of a V. parvula infected liver abscess associated with ARDS in an immunocompetent patient. Conclusion: These clinical findings are unique due to the nature of our patient’s ARDS onset and the dearth of similar cases in the literature. The favorable outcome of our patient was due to a multidisciplinary and early identification of a V. parvula hepatic abscess. The authors’ findings contribute to the future management of V. parvula and a greater understanding of its disseminating effects and presentation in immunocompetent patients.