(1537) Emerging Liver Infections Associated With Acute Respiratory Distress Syndrome

Introduction: Veillonella parvula is a strictly anaerobic gram-negative cocci that can be found in the normal flora of the oral cavity and the gastrointestinal tract. Despite its normal presence, Veillonella infections are rare in immunocompetent patients and cause periorbital cellulitis, endocarditis, osteomyelitis, and bacteremia. Acute Respiratory Distress Syndrome (ARDS) is most commonly caused by pulmonary and extrapulmonary sepsis, leading to lung injury and hypoxemia.

Description: A 36-year-old female with no reported medical history presented with right-sided chest, flank, and upper abdominal pain following a motor vehicle accident. Extended Focused Assessment with Sonography in Trauma (EFAST) was positive in the left and right upper quadrants. Computed Tomography (CT) showed multiple right rib fractures, a small right pneumothorax, grade 4 liver laceration along the posterior right lobe without any active extravasation. The patient was managed conservatively. However, by hospital day 2 the patient developed bilateral hazy consolidation with dense consolidation at the right lung base. The patient was placed on a high-flow nasal cannula with a right chest tube for pleural effusion. The patient was upgraded to the surgical intensive care unit (SICU) due to further desaturation, tachycardia, and tachypnea and required intubation. Chest CT at this time showed patchy multifocal ground-glass consolidation, left pleural effusion, and along with intraparenchymal liver abscess. Drainage and culture of the liver abscess resulted in the growth of Veillonella Parvula. After orotracheal intubation and mechanical ventilation with a low tidal volume strategy the patient made a quick recovery. The hepatic abscess was treated with a course of levofloxacin and metronidazole and the patient was discharged with a liver drain on hospital day 18.

Discussion: This case highlights V. parvula infected liver abscess causing sepsis and association with ARDS in an immunocompetent patient. Our findings contribute to future clinician management of V. parvula and the growing knowledge of its rare infection, dissemination, and presentation in immunocompetent patients who require critical care.