Liver abscess caused by Burkholderia pseudomallei in a young man: A case report and review of literature

Abstract

Pyogenic liver abscess is a common entity in Indian subcontinent and is mostly caused by gram negative bacteria. Melioidosis is not commonly seen in India and only a few cases are reported. It can give rise to multiple abscesses at different sites including liver. We report a case of isolated liver abscess caused by Burkholderia pseudomallei (B. pseudomallei) in a 29-year-old recently diagnosed diabetic, immunocompetent male. Diagnosis was made by imaging and culture of pus aspirated from the abscess and he was treated with percutaneous pigtail catheter drainage followed by antibiotics (meropenem and trimethoprim-sulphmethoxazole). Melioidosis is an emerging infection in India and has high mortality rate, so early diagnosis and prompt management is warranted which requires clinical vigilance and an intensive microbiological workup. Clinicians should be aware of isolated liver abscess caused by B. pseudomallei in appropriate clinical settings.

Keywords: Burkholderia pseudomallei; Diabetes; Emerging infection; India; Liver abscess.

Figure 1

Computed tomography. A: Chest radiograph shows elevation of right hemi-diaphragm; B: Contrast enhanced computed tomography of upper abdomen shows one loculated hypodense lesion (8.5 cm × 7.4 cm) with irregular inner margin noted in the right lobe of liver (black arrow); C: Multiple small hypodense lesions with confluences also seen in posterior part of right lobe.

Figure 2

Identification of bacteria. A: Showing dry wrinkled colonies on 5% sheep blood agar (48 h of incubation at 37%). Inset: colonies in enlarged view; B: Gram negative oxidase positive bacillus with typical bipolar “safety-pin” appearance on gram stain (black arrow).