Melioidosis in kidney transplant recipients: A report of two cases

Rationale: Melioidosis is a serious opportunistic infection caused by Burkholderia ( B. ) pseudomallei, primarily affecting immunocompromised individuals, particularly in endemic regions. Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes. Patient concerns: Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever, accompanied by liver and spleen abscesses. Case 2 was a 37-year- old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia. Blood cultures for both patients grew B. pseudomallei. Diagnosis: Both patients were diagnosed with melioidosis caused by B. pseudomallei , with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2. Interventions: Both patients were treated with an intensive regimen of meropenem (renal-adjusted doses), followed by a 3-month course of oral cotrimoxazole for eradication therapy. Outcomes: Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well. In Case 2, blood cultures became sterile after 4 weeks, with no further complications observed. Lessons: Melioidosis should be suspected in immunocompromised patients, especially kidney transplant recipients, who present with unexplained fever and sepsis-like symptoms. Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.