Infected aneurysm after returning from Southeast Asia: think Burkholderia pseudomallei!

Abstract

Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.

Keywords: bone and joint infections; cardiovascular system; infections; tropical medicine (infectious disease); urinary tract infections.

Figure 1

CT-scan showing a saccular infra-renal aortic aneurysm of 6 cm in diameter (white arrow).

Figure 2

Abdominal CT-scan showing septic thrombosis of the left common iliac portion of the endoprosthesis (black arrow), and a large peri-prosthetic infiltration (white arrow) (A); three-dimensional reconstruction abdominal CT-scan, showing septic thrombosis of the left common iliac portion of the endoprosthesis (white arrow) (B) and positron emission tomography scan showing a marked aortic peri-prosthetic ¹⁸F-fluorodeoxyglucose uptake (white arrow) and a left psoas muscle collection (black arrow) (C).

Figure 3

Superficial femoral veins were collected (A) and used for reconstruction of the aorto-iliac intersection (B).