Hepatic melioidosis - honeycomb liver abscess

Case contributed by Dr Ian Bickle

Presentation:

Right upper quadrant pain and fever

Patient Data:

Age: 50 years old
Gender: Male
Modality: CT

Large multiseptated 'honeycomb' abscess in the caudate lobe. Multiple tiny microabscesses in the spleen.Small collection or necrotic node inferior to the liver adjacent to pancreatic head.

Case Discussion:

Melioidosis is due to the Gram-negative bacterium, Burkholderia pseudomallei.  lt ia a saprophyte found in wet soils and is endemic to Southeast Asia and parts of Australia.  In rural areas muddy standing water in drains and ditches are commonplace. It occurs most commonly in those who are immunosuppressed in some form, particularly in those with diabetes mellitus. 

Although a wide range of organ systems can be involved the lungs, liver and spleen are the most common sites. It is common to observe involvement of various organs at the same time. A “honeycomb” appearance has been described as characteristic for large melioidosis hepatic abscesses.

The large lesions are typically multi-loculated and multi-septated, giving rise to the “honeycomb” appearance. This has been reported to be characteristic for melioidosis liver abscesses that are larger than 2 cm.

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