Burkholderia Pseudomallei: A Complicated, Potentially fatal, Case of Melioidosis with a Proposed Management Regimen

Abstract

We present an unusual case and management plan for a complicated case of Burkholderia Pseudomallei. A 75 year old male travelled to the United States from Southeast Asia, and presented acutely to the emergency room with fevers and difficulty breathing. He was diagnosed with a pulmonary embolus, following radiological imaging. Concurrently, with his acute presentation, he was found to have an underlying infection, diagnosed to be from Burkholderia Pseudomallei. He was treated initially with intravenous antibiotics and sent home with a prolonged regimen of oral antibiotics. Despite being on antibiotics, and being completely asymptomatic, he seeded the infection to his vascular graft. This was placed via endovascular technique to treat a ruptured right ileac artery aneurysm. The graft was placed well after the infection was diagnosed and treated. This bacteria is endemic to Southeast Asia, however, with global travel, the prevalence is increasing in multiple different countries and continents. A brief detailed review of Burkholderia Pseudomallei was undertaken and presented, along with a management plan for addressing the abdominal vascular infection. It is important for the clinician to maintain an index of suspicion in the setting of patient presentation, occupation, recent travel and both radiological and pathological findings.