Meliodosis

Case contribution: Dr Radhiana Hassan

Clinical:

• 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 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

Discussion:

• 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