A case of thoracic empyema due to suppurative melioidosis

Melioidosis is considered a rare disease in Hong Kong, and its diagnosis and treatment can be difficult. We report the case of a patient who presented with thoracic empyema. The material sampled from the empyema was initially labelled Burkholderia cepacia. The diagnosis of melioidosis due to Burkholderia pseudomallei could only be made after repeated cultures, and performing arginine dihydrolase and serological tests. The patient was initially treated with imipenem for 2 weeks, and then with ciprofloxacin as maintenance therapy. A resistant strain of the organism developed after 7 months of treatment. The patient was then given co-amoxiclav. Repeated courses of surgical drainage and debridement were also instituted. Subsequent computed tomographic scanning of the thorax showed gradual resolution of the empyema.