Disseminated melioidosis presenting with multifocal thoracic aortic mycotic aneurysms: A case report

Melioidosis, caused by Burkholderia pseudomallei (B. pseudomallei), is endemic to Southeast Asia and northern Australia, with clinical manifestations ranging from localized infection to life-threatening disseminated disease. Mycotic aneurysm is a rare but serious complication of disseminated melioidosis, associated with high morbidity and mortality.

We describe a case of a 67-year-old man with diabetes mellitus who presented with B. pseudomallei bacteremia complicated by multiple deep-seated abscesses and multifocal mycotic aneurysms of the descending thoracic aorta. Despite appropriate antimicrobial therapy, serial imaging demonstrated progressive aneurysmal enlargement. Surgical repair was recommended but declined by the patient. He was managed conservatively with prolonged antimicrobial therapy and close clinical and radiological monitoring.

This case illustrates the aggressive nature of disseminated melioidosis with vascular involvement and highlights the need for early diagnosis and multidisciplinary management to improve outcomes.