Abstract
We describe a case of melioidosis presenting as acalculous cholecystitis in a middle-aged Chinese male. The patient presented with clinical features of cholecystitis and computed tomography (CT) imaging did not reveal other obvious sources of sepsis other than acalculous cholecystitis. The decision was made by the hepatobiliary team to proceed with an urgent cholecystectomy in view of patient's septic presentation. Cultures from peripheral blood and intraoperatively obtained bile fluid grew Burkholderia pseudomallei. The patient subsequently completed one month of meropenem, followed by another three months of eradication therapy. The patient denied soil contact in his work but he comes from a melioidosis-endemic country. He was also newly diagnosed with diabetes mellitus during his admission. We believe this to be the first reported case of melioidosis presenting as acalculous cholecystitis with a positive bile fluid culture. Urgent cholecystectomy in susceptible cases, with positive contact history or from endemic countries, might present another modality to achieve source control. Appropriate antibiotics with melioidosis coverage should be started early as well.
Highlights
Melioidosis, called Whitmore's disease, is caused by Burkholderia pseudomallei, which is a gram-negative aerobic rod-shaped bacterium that is soil-dwelling and endemic in the tropics [1]
We describe a case of melioidosis presenting as acalculous cholecystitis in a middle-aged Chinese male
The patient presented with clinical features of cholecystitis and computed tomography (CT) imaging did not reveal other obvious sources of sepsis other than acalculous cholecystitis
Summary
Melioidosis, called Whitmore's disease, is caused by Burkholderia pseudomallei, which is a gram-negative aerobic rod-shaped bacterium that is soil-dwelling and endemic in the tropics [1]. The patient was a 55-year-old Chinese male with no nationwide records of any significant past medical history He was a current smoker and consumed alcohol daily. It was established later that he had undiagnosed diabetes mellitus with a glycated haemoglobin of 10.5% He was discharged from the ICU after a prolonged stay of almost a month and suffered additional complications of dry gangrene of his hands and feet from the severe sepsis and high inotropic requirements. He was continued on intravenous meropenem for a month before converting to enteral trimethoprim and sulfamethoxazole for another three months
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