Melioidosis in acute cholangitis of diabetic patient: a forgotten diagnosis

Nasir Mohamad,¹ Suresh Ponnusamy,² Sunita Devi,³ Rishya Manikam,⁴ Ilya Irinaz Idrus,¹ Nor Hidayah Abu Bakar<sup>5

1</sup>Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; ²AIMST University, Bedong, Malaysia; ³Hospital Sultan Abdul Halim, Sungai Petani, Malaysia; ⁴University Malaya Medical Centre, Kuala Lumpur, Malaysia; ⁵Department of Pathology, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia

Abstract: Melioidosis presents with a wide range of clinical presentations, which include severe community-acquired pneumonia, septicemia, central nervous system infection, and less severe soft tissue infection. Hence, its diagnosis depends heavily on the clinical microbiology laboratory for culture. In this case report, we describe an atypical presentation of melioidosis in a 52-year-old man who had fever, right upper-abdominal pain, and jaundice for 15 days. Melioidosis caused by Burkholderia pseudomallei was subsequently diagnosed from blood culture. As a primary care physician, high suspicion index is of great importance. High suspicion index of melioidosis in a high-risk group patient, such as the patient with diabetes mellitus and diabetic foot, is crucial in view of atypical presentations of pseudomonas sepsis. A correct combination of antibiotic administration in the early phase of therapy will determine its successful outcome.

Keywords: Burkholderia pseudomallei, atypical, high suspicion, primary care