Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.604
Revised: June 14, 2014
Accepted: July 25, 2014
Published online: October 16, 2014
Processing time: 240 Days and 17.6 Hours
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.
Core tip: Liver abscess due to Burkholderia pseudomallei (B. pseudomallei) is extremely rare and is mostly reported from Taiwan. In India, most of the reports of are from southern coastal India and this entity is exceedingly rare in eastern India. The actual magnitude of this emerging infection may be under reported due to non-availability of confirmatory tests. Accurate diagnosis is necessary as outcome is fatal with ineffective treatment. We report a case of multiple liver abscesses caused by B. pseudomallei in a 29-year-old diabetic male, who was referred as a case of recurrence of pyogenic liver abscess which was previously caused by pseudomonas not responding to antibiotic therapy and aspiration. Diagnosis was made by imaging and culture of aspirated pus revealed B. pseudomallei and he was treated successfully with surgical drainage and prolonged course of intravenous and oral antibiotics. So, in a case of pyogenic liver abscess not responding to conventional antibiotics, B. pseudomallei should always be thought as a possibility which can be identified by its characteristic appearance on culture and microscopy or direct immunofluorescence testing as well as unique imaging features.