Visceral meliodosis

Case contribution: Dr Radhiana Hassan


  • A 41 years old man with underlying DM, HPT and dyslipidaemia
  • Presented with right hypochondriac pain for 4 days
  • Associated with fever for one week
  • Also had nausea and reduced oral intake.
  • Condition worsened and admitted for 5 days in ICU due to sepsis.
  • Blood culture: Burkholderia pseudomallei, HBA1C=13.4%
Abdominal radiograph AP supine view which shows no significant finding


Ultrasound hepatobiliary system

Ultrasound findings:

  • The liver has normal parenchyma echogenicity. It has smooth margin. Liver is enlarged measuring approximately 18 cm at midclavicular line.
  • There is a hypoechoic lesion with ill-defined margin seen at segment VI measuring 3.3 x 4.0 x 4.3 cm (AP x W x CC). This lesion has internal septations and echogenic debris within.
  • Spleen is enlarged measuring 14.0 cm. There is a hypoechoic lesion with ill-defined margin adjacent to the hilum measuring approximately 2.0 x 3.1 cm (AP x W). This lesion has internal septations and echogenic debris within.
CT scan abdomen in axial planes soft tissue window post contrast

CT scan findings:

  • Liver is enlarged measuring about 25 cm in craniocaudal length. It shows fatty change.
  • Two peripherally enhancing ill-defined multiloculated lesions with central low attenuation are identified in segment VI and IV (yellow arrows). They are measuring 3.9 x 3.3 x 3.2 cm and 2.8 x 3.5 x 2.2 cm (AP x W x CC) respectively suggestive of abscesses.
  • The gallbladder is distended with thickened enhancing wall and pericholecystic fluid collection. No layering density within. No gallbladder calculus. Gallbladder wall is intact.
  • Ill-defined multiloculated non-enhancing hypodense lesion is also seen in the upper pole of the spleen measuring 3.6 x 1.8 x 2.3 cm (AP x W x CC). Reactive fluid is seen medially adjacent to this collection in the splenic hilum.
  • The splenic hilar vessels are grossly patent and not thrombosed.

Diagnosis: Meliodosis with spleen and liver abscesses.


  • Meliodosis is a bacterial infection caused by Burkolderia pseudomallei
  • It is most commonly infects adult with underlying predisposing factors mainly diabetes mellitus.
  • Spleen is the most commonly affected extrapulmonary visceral organ.
  • Splenic lesions are often multiple, small and discrete varying from 0.5 cm to 1.5 cm, single or multiloculated lesions, subcapsular collections with or without peripslenic extension.
  • Concurrent spleen and liver abscesses are more likely to be associated with meliodosis than with infections with other organisms.
  • Liver is the second most common visceral organ affected by meliodosis. Similar with splenic lesion, appearance on imaging may varies. Liver involvement is usually part of multi-organ involvement rather than a solitary organ involvement.
  • Other organs to be involved: kidneys and prostate
  • Rare involvement: bowel and peritoneum causing enteritis, colitis and peritonitis

Progress of patient:

  • Completed IV meropenem followed by Bactrim.
  • Patient responded and discharged well.
  • A repeat CT scan 3 months later shows resolution of abscesses foci.
Author: radhianahassan