(559) Refractory Shock due to Parvimonas Bacteremia

Introduction: Parvimonas spp. are colonizers of different parts of the human body, particularly the GI tract. Typically regarded as a normal flora, Parvimonas spp. have gained attention as opportunistic pathogens, causing a variety of infections associated mainly with the oral cavity such as dental abscesses and periodontal disease. Parvimonas micra bacteremia has rarely been described in cases of bacteremia in the literature. Herein we present a unique case of septic shock due to Parvimonas micra bacteremia.

Description: 71 yo M with Hx of alcohol abuse was admitted for AMS after being found down at home. He required intubation for airway protection due to repeated hematemesis. His initial CT of the abdomen and pelvis revealed mild pancreatitis. EGD revealed a gastric antral ulcer with no active bleeding and no varices. He appeared to have stabilized but over the next 24 hours went into worsening shock. He was resuscitated with crystalloids and blood products due to a suspected hemorrhagic component, but he went on to require norepinephrine and vasopressin infusions. His hemoglobin remained stable but had worsening leukopenia and renal failure. Abdominal US showed only trace ascites. Given his stable hemoglobin, sepsis was suspected so he was pan-cultured and started on piperacillin-tazobactam. He continued to require norepinephrine for several days despite other adjunct therapies, such as hydrocortisone. Final blood cultures revealed a Gram-positive anaerobic coccus which was identified as Parvimonas micra.

Discussion: Parvimonas micra has recently been identified as a cause of bacteremia in the literature thanks to laboratory advancements, particularly MALDI-TOF MS. Previous cases involved esophageal cancer, colonic cancer, ERCP, and dental origins. Like other Gram-positive anaerobes causing bacteremia, mortality rates can be high. Thankfully, there is a high susceptibility of Parvimonas micra to antibiotics. Performing a comprehensive evaluation including chest, abdomen, and pelvis CT scan, as well as endoscopy/colonoscopy, to screen for potential occult gastrointestinal tract malignancy at an early localized stage is of utmost importance. Our patient’s pancreatitis and GI bleed were likely opportunities for translocation of this bacteria into his bloodstream causing our clinical picture.