Non-septicemic Burkholderia pseudomallei liver abscess in a young man
Ren-Jy Ben, Yuh-Yuan Tsai, Jyh-Ching Chen, Nan-Hsiung Feng
Divisions of Infectious Diseases and Gastroenterology, Department of Internal Medicine; and Department of Radiology, Kaohsiung Military General Hospital, Kaohsiung, Taiwan, ROC
Received: September 1, 2003 Revised: October 20, 2003 Accepted: October 27, 2003
Melioidosis, caused by Burkholderia pseudomallei, has been increasingly recognized in Taiwan recently. Its isolation in liver abscess is rare compared to pulmonary melioidosis. We report a case of liver abscess due to B. pseudomallei in an immunocompetent 27-year-old male soldier admitted due to fever, sore throat and mild non-productive cough for 1 week. Physical examination was unremarkable except for congestion of the pharyngeal wall, moderate enlargement of the tonsils without pus coating, and palpable tender lymphadenopathy over bilateral submental regions. Antibiotic treatment with cefazolin 1 g every 8 hours intravenously was given without response. Left flank pain, followed by right flank pain associated with epigastric tenderness developed. Sonography and computed tomography scan of the abdomen demonstrated liver abscess. Aspiration of the liver abscess was performed and abscess culture yielded B. pseudomallei. Treatment with ceftazidime 2 g every 8 hours intravenously (4 weeks' duration) followed by oral regimens of amoxicillin-clavulanate was given. The patient was free of symptoms at 8 months' follow-up. Early awareness and definite diagnosis as well as institution of proper antimicrobial agents are imperative for successful treatment of melioidosis.
Burkholderia pseudomallei, case reports, liver abscess, melioidosis
J Microbiol Immunol Infect 2004;37:254-257.