Pancreatic involvement in melioidosis.

Area of Science:

• Infectious Diseases
• Tropical Medicine
• Gastroenterology

Background:

• Melioidosis is an infectious disease endemic to tropical regions.
• Intra-abdominal abscesses are common in melioidosis, but pancreatic involvement has not been previously documented.

Observation:

• This study retrospectively reviewed 65 patients with melioidosis who underwent computed tomography (CT) scans.
• Four cases (6.2% prevalence) of pancreatic melioidosis were identified, all with predisposing conditions like diabetes or thalassemia.

Findings:

• Pancreatic melioidosis presented with symptoms including fever, anorexia, weight loss, rigor, and abdominal pain, with a median duration of six weeks.
• CT scans revealed multifocal micro-abscesses or large abscesses involving all pancreatic sections, often alongside multi-organ involvement (blood, liver, spleen, lung).
• Associated findings included splenic vein thrombosis, peripancreatic inflammation, and fat streaking.

Implications:

• Pancreatic involvement in melioidosis typically occurs with multi-organ disease and presents as micro-abscesses.
• All identified pancreatic abscesses resolved with antibiotic therapy, negating the need for drainage procedures.
• This highlights the importance of considering pancreatic involvement in melioidosis patients and the efficacy of conservative management.