Case contribution: Dr Radhiana Hassan


  • A 58 years old man with underlying DM, hypertension and hyperlipidaemia
  • Presented with high grade fever, chills and rigor for 5 days
  • Associated with poor oral intake
  • No URTI symptoms
  • No UTI symptoms
  • No rashes, No history of contact with COVID-19 patients
  • WBC: 5.7, CRP=26.8, Mantoux test –ve, CXR normal
  • ECHO no vegetation, US abdomen normal, Dengue serology –ve, Blood C&S Burkholderia pseudomallei
CT scan thorax, abdomen and pelvis in axial planes, lung and soft tissue windows

CT scan findings:

  • CT scan was performed to look for occult abscesses as CXR and US were normal
  • CT scan shows a few cavitating lesions in both lungs (yellow arrows)
  • Subcentimetres mediastinal nodes are seen. No pleural effusion.
  • Multiple small rim enhancing lesions are also seen in the liver ( red arrows) and spleen ( blue arrows). NO similar lesion in the prostate gland.
  • No ascites, no abnormal enlargement of paraortic or paracaval nodes

Diagnosis: Meliodosis


  • Melioidosis is an infection caused by Burkholderia pseudomallei
  • Melioidosis most commonly infects adults with an underlying predisposing condition, mainly diabetes mellitus.
  • Melioidosis has a wide range of radiological manifestations making it a great mimicker.
  • Diagnosis requires a high index of clinical suspicion in patients with septicemia or a fever of unknown origin living in or with a travel history to endemic areas.
  • Almost every organ can be affected.
  • Pulmonary manifestation include small nodules, typically affecting the upper lobes that may rapidly progress in cavitation or pulmonary abscess formation. Pleural effusions are uncommon.
  • Head and neck manifestation includes suppurative parotitis.
  • Abdominal manifestation most commonly involving the liver and spleen. Pancreas, kidneys and prostate glands are other organ that can be affected.
  • CNS involvement is uncommon, ranging from cerebral abscess, cerebritis and dural venous thrombosis
Author: radhianahassan