Chronic Melioidosis Presenting with Pneumonia, Empyema, and Splenic Abscess

Melioidosis is an emerging tropical infectious disease with diverse clinical manifestations and a high fatality rate. We report a rare case of chronic melioidosis manifesting as pulmonary infection, empyema, and splenic abscess. The patient presented with recurrent chest pain, cough, and abdominal discomfort for 11 months, initially misdiagnosed as common bacterial infection. Computed tomography imaging revealed pulmonary infection, left pleural effusion, and multiple abnormal low-density lesions in and around the spleen. Pleural effusion culture identified Burkholderia pseudomallei. Management included thoracic puncture and catheter drainage, an intensive phase of intravenous ceftazidime, followed by an eradication phase with oral trimethoprim/sulfamethoxazole. The patient showed clinical and radiological improvements. Clinicians should consider chronic melioidosis in patients with pneumonia and parapneumonic pleural effusion accompanied by splenic abscesses, particularly in patients with diabetes mellitus from endemic areas. Early recognition, definitive diagnosis, and tailored antimicrobial therapy are essential to prevent the progression of severe pneumonia and sepsis.