Disseminated melioidosis with multiple visceral abscesses including prostatic abscess

Chronic Melioidosis Presenting with Pneumonia, Empyema, and Splenic Abscess

ABSTRACT. 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.

Disseminated melioidosis complicated by symmetrical peripheral gangrene and multi-organ failure: a case report

Background Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection endemic to Southeast Asia and northern Australia. Disseminated disease with bacteremia and multifocal organ involvement carries high mortality, particularly among patients with diabetes mellitus (DM) and hazardous alcohol use. Symmetrical peripheral gangrene (SPG) is a rare complication that may result in permanent disability. Case presentation A 57-year-old man with poorly controlled type 2 DM, chronic alcohol use, and malnutrition presented with septic shock and acute hypoxemic respiratory failure. Imaging revealed cavitary pneumonia and abscesses involving the liver, kidney, and prostate. Two independently collected blood cultures and a prostatic abscess aspirate yielded B. pseudomallei, confirmed through a multistep microbiological workflow with final VITEK 2 identification. The patient required vasopressors, mechanical ventilation, continuous venovenous hemofiltration, intravenous meropenem, and image-guided drainage of the prostatic abscess. Distal cyanosis was present at admission and progressed to dry gangrene of multiple fingers and toes. The symmetric acral distribution and absence of major-vessel obstruction were clinically consistent with SPG. Recurrent hyperkalemia and renal dysfunction prevented continued trimethoprim-sulfamethoxazole therapy, necessitating six months of doxycycline plus amoxicillin-clavulanate. Secondary infection and osteomyelitis of the gangrenous digits required multiple amputations. At follow-up 11 months after completion of eradication therapy, there was no evidence of recurrent melioidosis. Conclusion SPG is a rare but devastating complication of disseminated melioidosis. Prompt antimicrobial therapy, intensive organ support, source control, and early recognition of peripheral ischemia are important. Even after survival and successful treatment, substantial long-term functional disability may persist.

Melioidosis: A Review and Update for the Special Operations Provider.

Melioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei - a Tier 1 Select Biological agent - remains a significant cause of severe community-acquired infection in tropical regions, but with recent expanding recognition in temperate climates, including the United States. Pulmonary involvement is the most frequent clinical manifestation, ranging from subclinical nodules to fulminant necrotizing pneumonia and acute respiratory distress syndrome. Despite its clinical severity, melioidosis remains underdiagnosed due to its radiologic mimicry of tuberculosis, broad clinical manifestations, and limited laboratory capacity in many endemic areas. Special Operations Forces (SOF) participating in field exercises or operations in B. pseudomallei endemic countries are at significantly increased risk of infection. Accordingly, SOF medical providers should maintain a high index of suspicion for melioidosis and be familiar with its clinical recognition, diagnosis, and management.

Fulminant Intestinal Amebiasis in a Young Female Patient: A Case Report

Campylobacter bacteremia with psoas abscess: Case Report and review of the literature

Infection with Campylobacter fetus can result in bacteremia and disseminated endovascular infection or extraintestinal infections such as osteomyelitis, septic arthritis, or meningoencephalitis. We present a case of a 36-year-old man with HIV who developed bacteremia and a left psoas muscle abscess after an acute episode of gastroenteritis due to C. fetus. The gastroenteritis appeared to resolve rapidly, but weakness, fatigue, and back pain started the following week. Magnetic resonance imaging of the lumbar spine revealed a left psoas abscess. The patient was treated with ertapenem for four weeks and had a resolution of back pain at the three-month follow-up visit but was then lost to follow-up. This case highlights the importance of accurate initial identification and treatment of systemic campylobacteriosis in immunocompromised hosts and the potential for dissemination.

Extrapulmonary Tuberculosis with Seminal Vesicle Involvement in an Immunocompetent Patient.

ABSTRACT Extrapulmonary tuberculosis often presents diagnostic challenges due to its involvement in multiple organ systems. We report a case of a 54-year-old, immunocompetent man who presented with prolonged fever and a generalized seizure. Neuroimaging revealed ring-enhancing lesions suggestive of tuberculomas. Further evaluation demonstrated a seminal vesicle abscess and cervical lymphadenitis. Histopathology and microbiological analysis confirmed Tuberculosis. The patient was initiated on antitubercular therapy, along with anti-convulsants and steroids. This case highlights the importance of considering EPTB in patients with sterile pyuria, neurological symptoms, even in immunocompetent individuals without a pulmonary disease.