Disseminated Melioidosis Complicated by Right-Sided Infective Endocarditis: A Rare Case of Pulmonary Valve...

Melioidosis caused by gram-negative bacilli, Burkholderia pseudomallei, can present with a wide range of illnesses, from pneumonia and cutaneous infection to disseminated disease with severe septicemia.

A 55-year-old man with newly diagnosed diabetes presented with fever and productive cough. Chest radiograph showed right-sided lobar pneumonia. Blood cultures, endotracheal tube culture and sensitivity testing, and bronchoalveolar lavage confirmed a diagnosis of disseminated melioidosis. Transesophageal echocardiography showed a large, 4.8 × 1.28 cm mass at the pulmonary valve, another mass at the tricuspid valve, and inferior vena cava thrombus. Left ventricular ejection fraction was significantly reduced (21%). These findings were suggestive of right-sided infective endocarditis. The patient was treated medically with intravenous meropenem, gentamicin, vancomycin and trimethoprim-sulfamethoxazole for 6 weeks, and anticoagulation was started, leading to complete resolution of the vegetation and clot.

We present a rare case of right-sided infective endocarditis involving the pulmonary valve secondary to B pseudomallei.

Early recognition and prompt antimicrobial treatment are crucial in right-sided infective endocarditis secondary to melioidosis, which often presents with predominant respiratory symptoms and requires a high index of suspicion.