Multiple liver, splenic and psoas abscesses due to melioidosis: A case report

Melioidosis is caused by community-acquired gram-negative bacillus Burkholderia pseudomallei which resides in soil and water. It was first described in 1912 in Burma and 1927 in Sri Lanka. Melioidosis presents with non-specific clinical and biochemical findings. Diagnosis is confirmed by the isolation of bacteria in cultures or demonstrating antibody response. Once the diagnosis is made, patients are managed with a course of intravenous antibiotics followed by a long course of oral antibiotics. Even with antibiotic treatments, most patients do not achieve complete recovery which results in chronic disease. Prolonged antibiotic therapy makes patients less compliant with treatment. Here we present a 50-year-old Sri Lankan male with diabetes mellitus presented with low-grade fever and back pain. He was found to have multiple abscesses involving the liver, spleen and left psoas muscle. Initially, he was evaluated for tuberculosis and later only melioidosis was diagnosed. The patient was managed with guided aspiration of abscesses and intravenous antibiotics. Subsequently, the patient defaulted on all treatments. It is important to consider melioidosis as a differential diagnosis in immunocompromised patients presented with multiple abscesses. It is important to maintain a registry for follow-up melioidosis patients to prevent becoming chronic melioidosis patients and to save healthcare costs.