Abstract
Background: Melioidosis, caused by Burkholderia pseudomallei, is an important cause of community-acquired septic shock in endemic tropical regions. Its ability to mimic other conditions and form deep-seated abscesses presents a significant challenge in the intensive care unit (ICU), particularly in patients without traditional risk factors such as diabetes.
Case presentation: A 45-year-old nondiabetic male presented with a 15-day history of fever and pleuritic chest pain. His clinical course was complicated by the rapid onset of fulminant septic shock, acute kidney injury, and acute respiratory distress. Initial management focused on hemodynamic stabilization with vasopressors and non-invasive ventilation. Rapid identification using matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry confirmed B. pseudomallei bacteremia. Management required precision dosing of meropenem adjusted for fluctuating renal function. Despite achieving microbiological clearance, persistent febrile episodes prompted further evaluation, leading to the discovery of a large (5.8 x 6.4 cm) prostatic abscess. The patient was successfully managed with a combination of high-dose intensive-phase antibiotics and targeted source evaluation, thereby avoiding the need for invasive drainage.
Conclusion: In endemic areas, melioidosis must be considered in the differential diagnosis of refractory septic shock. This case highlights the necessity of rapid microbiological identification and a high index of suspicion for occult foci, such as prostatic abscesses, which can impede clinical recovery in the ICU.
Kavya Yanamadala, Vaishnavi S., Sivaprakash V., RB Sudagar Singh
