A Case of Fever of Unknown Origin -? Melioidosis Presenting as Severe Sepsis and Multiple Organ Dysfunction Syndrome

Abstract

Melioidosis is an emerging infection in India1, well known for its protean clinical manifestations. We report a case of probable disseminated Melioidosis with hyperferritinemic septic shock and multi organ dysfunction syndrome. She presented as a case of PUO- with high fever- 1week, loose stools, headache and shortness of breath, to our hospital. She had a turbulent course in hospital, with fever not responding despite 2 weeks of hospitalization. Her respiratory system showed bilateral crackles. Per Abdomen examination revealed tenderness in right iliac fossa, suprapubic region and left iliac fossa, bowel sounds were sluggish. CECT chest and Abdomen showed right basal pneumonia, hydro-ureteronephrosis, with ureter showing narrowing at the region of right adnexa, PID, subcentrimetric , mesentric , and perirectal lymph nodes; rectal wall showing inflammatory changes with inflammation of mesorectal fascia . She responded well and fully recovered with injection Meropenem for 8 weeks; followed by oral Trimethoprim-Sulfamethoxazole for 3 months.