The Great Mimicker: A Case of Disseminated Melioidosis with Extensive Abscesses and Successful Outcome in an Elderly Male

Introduction: Burkholderia pseudomallei causes melioidosis, a tropical disease common in Southeast Asia [1]. It typically manifests as pneumonia or intra-abdominal abscesses, diagnosed by culture, and treated with specific antibiotics. Objective: To discuss the diagnostic and therapeutic complexities encountered in a case of disseminated melioidosis presenting with atypical presentation of facial swelling and a neck mass in an individual with newly diagnosed type 2 diabetes mellitus. Who has no known exposure to contaminated soil and has not engaged in rice farming. Case presentation: A 62-year-old male presented with facial swelling and an enlarging neck mass. A computed tomography (CT) scan of the neck and chest revealed a rim-enhancing collection in the right lateral cervical region with loculations, extensions, and surrounding inflammatory changes, consistent with abscess formation. Additional rim-enhancing, hypodense collections were observed in the right paratracheal, paraesophageal, and prevertebral regions extending from T1 to T4, indicative of disseminated abscess formation. These imaging findings, in conjunction with systemic manifestations, raised concerns for disseminated infection. Management: The patient underwent serial wound debridement to remove the accessible necrotic tissue and facilitate abscess drainage. Cultures grew B. pseudomallei. Deeper-seated infections were managed conservatively with a four-week course of intravenous meropenem, a first-line therapy for severe melioidosis. This integrated therapeutic strategy, encompassing surgical intervention and prolonged antibiotic administration, is consistent with established clinical guidelines for disseminated melioidosis. Follow-up imaging revealed resolution of the abscesses. Conclusion: This case underscores the considerable diagnostic challenges and intricate clinical course associated with disseminated melioidosis, mandating a heightened index of suspicion, particularly within endemic geographical areas. Despite the complexity of therapeutic management, achieving a favorable clinical outcome remains a viable possibility.