Melioidosis

Case contributed by Dr Akshit Aiyappa M J

Presentation

Presented with abdominal pain and generalized weakness for 1 week. Known diabetes mellitus, on treatment

Patient Data

Age: 50 years
Gender: Male
CT

Multiseptated collection of cystic attenuation in the peripancreatic region along the tail of pancreas and in perisplenic region. Post-contrast scan shows enhancement of the wall and septa. This collection extends along the splenic hilum and anterior pararenal space and compresses the splenic vein. Splenic artery is normal.

Enlarged spleen with multiple small non-enhancing hypodense foci.

Multiple peripancreatic, pre- and para-aortic, and mesenteric lymph nodes noted.

Minimal ascites and mild left pleural effusion noted.

Significant hydrocele.

Case Discussion

CT-guided pigtail insertion was performed. The sample was sent for culture and sensitivity:

  • Specimen: pus
  • Organisms isolated: Burkholderia pseudomallei (Pseudomonas species)

The patient was treated non-operatively.

Melioidosis is an infection caused by Burkholderia pseudomallei. Diabetes mellitus is one of the predisposing factors. The lungs are the most commonly affected organs, followed by skin, subcutaneous tissue, spleen, liver, bones and joints. The splenic lesions are usually multiple, discrete, and small with associated subcapsular collections. Differential diagnosis includes other infective conditions such as tuberculosis. 

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