Chronic Melioidosis Presenting with Pneumonia, Empyema, and Splenic Abscess.
Yamei Zheng, Xiaozhou Yao, Min Wang et al.
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Case in brief
A patient with recurrent chest pain, cough, and abdominal discomfort over 11 months had initially been treated for a common bacterial infection. CT showed pulmonary infection, a left pleural effusion, and multiple low-density lesions in and around the spleen. Culture of pleural fluid grew Burkholderia pseudomallei, establishing chronic melioidosis with pneumonia, empyema, and splenic abscesses. The patient underwent thoracic drainage and received intravenous ceftazidime followed by oral trimethoprim/sulfamethoxazole, with clinical and radiological improvement.
What made this case unusual
The combination of chronic pulmonary melioidosis and empyema with multiple splenic lesions presented after a prolonged course and was initially mistaken for common bacterial infection.
Diagnostic / clinical pearl
In a patient with pneumonia and parapneumonic effusion plus splenic lesions, consider melioidosis, particularly with diabetes and residence in an endemic area; pleural-fluid culture can establish the diagnosis.