Disseminated Melioidosis Complicated by Prostatic Abscess and Splenic Involvement: Diagnostic and Therapeutic Insights

This case report details the clinical course of a 53-year-old male farmer with a 15-year history of diabetes mellitus who presented with a 20-day history of pyrexia, rigors, and shivering, as well as problems in the urogenital system and left hypochondrial pain. Notably, he had been diagnosed with spinal tuberculosis, which was successfully treated five years ago. On evaluation, there was tenderness in the suprapubic region as well as the left hypochondrium; moreover, rectal examination showed that the prostate was boggy and tender. The laboratory tests revealed microcytic hypochromic anemia, increased inflammatory markers, and uncontrolled diabetes. Imaging studies reported splenomegaly containing multiple low-density lesions accompanied by cystitis and a prostatic abscess. Positive blood culture samples indicated <i>Burkholderia pseudomallei,</i> thereby signifying disseminated melioidosis. He underwent cystoscopy followed by prostatic deroofing and received intravenous meropenem and prolonged oral cotrimoxazole treatment thereafter. Within 10 days after the initiation of treatment, significant symptomatic relief was achieved. This report highlights the need for a high index of suspicion for melioidosis in systemic infection patients with diabetes and emphasizes prompt surgical intervention along with appropriate medical therapy in complex cases, especially those involving a non-clear-cut diagnosis or severe disease presentation.