Melioidosis presenting as a solitary atypical liver abscess: A case report and review of the literature

Abstract

Melioidosis, caused by Burkholderia pseudomallei, can present from asymptomatic infection to severe disseminated abscesses. Hepatic involvement is typically seen in disseminated cases, with isolated liver abscesses being uncommon. We present a case of a 42-year-old male with a three-week fever and newly diagnosed diabetes mellitus. His white cell count and CRP were elevated. Abdominal ultrasound showed a heterogeneous mass in liver segment IV, with central cystic lesions. CT revealed an isolated liver abscess with a honeycomb appearance and extra-hepatic extension. A provisional diagnosis of melioidosis was made. The patient was treated with IV meropenem 1 g tds, followed by oral co-trimoxazole 960 mg bd for three months, extended one more month after radiological resolution. Melioidosis was confirmed by an Indirect Hemagglutination Assay (IHA) with a titre of 1:320 at eight weeks. This case highlights the importance of clinical suspicion and early recognition of rare manifestations of melioidosis for timely diagnosis and treatment.