Splenic granuloma: Melioidosis or Tuberculosis?

Area of Science:

• Infectious Diseases
• Microbiology
• Clinical Medicine

Background:

• Melioidosis, caused by Burkholderia pseudomallei, is a significant infectious disease known for its diverse clinical presentations.
• While acute infections are common, approximately 18% of cases manifest as chronic infections, posing diagnostic challenges.

Observation:

• Chronic splenic granuloma is an uncommon but recognized manifestation of Melioidosis.
• Latent infections can reactivate, leading to severe, fulminant disease, often misdiagnosed as tuberculosis due to limited clinical suspicion and laboratory resources.

Findings:

• Deep-seated abscesses necessitate prolonged intravenous antibiotic therapy (at least 4 weeks).
• Ceftazidime, a primary treatment, can induce thrombocytopenia, a risk potentially amplified by concurrent diclofenac use.

Implications:

• Recognizing rare presentations like splenic granulomas is vital for accurate Melioidosis diagnosis.
• Alternative antibiotic choices, such as meropenem, may be life-saving in complicated cases or when drug-induced complications arise.