Melioidosis: A Rare Cause of Liver Abscess

Abstract

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth of Burkholderia pseudomallei in which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound. Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused by Burkholderia pseudomallei has not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

Non-bacteremia liver abscess caused by Burkholderia pseudomallei from a tertiary teaching hospital in Malaysia: a case report and literature review

“…There is no clear-cut duration of maintenance antibiotics but the duration of 3 to 6 months is recommended in many reports (Puthucheary, 2009). Similarly, from the previous case reports, the duration of maintenance therapy was between 3 to 6 months (Lee et al, 2006;Pal et al, 2014;Martin et al, 2016). There was no surgical or percutaneous drainage of the abscesses performed in our patient due mainly to the multiple lesions in both lobes.…”

“…There was no surgical or percutaneous drainage of the abscesses performed in our patient due mainly to the multiple lesions in both lobes. Previously, in some cases of hepatic melioidosis, the insertion of percutaneous drainage of the liver abscess had been performed with the combination of appropriate antibiotic therapy associated with complete resolution of the abscess confirmed by follow-up radiological study (Pal et al, 2014;Martin et al, 2016).…”

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions – infectious (bacterial)

“…Melioidosis is endemic in tropical areas, specifically in Northeast Thailand and Northern Australia, but also in other regions of Southeast Asia, China, India and territories across the tropics. [88][89][90][91][92][93][94][95][96][97]. Melioidosis is endemic in regions which have tropical monsoon climates and abundant rainfall [90].…”

Melioidosis in the Philippines

“…Indigenous cases, meaning those with no apparent travel history to other endemic areas, and who were diagnosed and treated in the Philippines, had never been reported in the literature until 2002, when a 49-year-old farmer from Bulacan in the Philippines presented with pain and swelling of the left shoulder and was found to have melioidosis after Burkholderia pseudomallei was isolated from blood [ 14 ]. The second indigenous case, and the first case published in an international journal, was reported as recently as 2016 [ 15 ]. The patient was a farmer from Isabela with no history of travel outside the country, who was diagnosed and treated in a hospital in Metro Manila.…”