Available online 15 May 2024

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Melioidosis is an infectious disease caused by Burkholderia pseudomallei. People infected with B. pseudomallei experience fever and skin changes, pneumonia, abscesses, and septic shock that could cause death. Hemophagocytic lymphohistiocytosis is a severe inflammatory syndrome due to the excess activation of macrophages and T cells. We report a 50-year-old hypertensive and diabetic male patient presented with high-grade intermittent fever with loss of appetite and weight loss for two months and a history of jaundice, backache and swelling of both feet for 15 days. Blood and bone marrow culture grew Burkholderia pseudomallei. A liver biopsy revealed Kupffer cell hyperplasia and hemophagocytosis. The patient was treated with an injection of dexamethasone 4mg intravenous three times a day for five days and tapered over 15 days with ceftazidime 2 gm intravenous three times a day for six weeks. Early suspicion in the diagnosis of hemophagocytic lymphohistiocytosis in septicemia can prevent severe complications, even death.

Section snippetsIntroduction:

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, predominantly a disease of tropical climates, especially in Southeast Asia and Northern Australia 1, 2, 3. People infected with B. pseudomallei experience fever and skin changes, pneumonia, abscesses, and septic shock that could cause death [4].

Hemophagocytic lymphohistiocytosis (HLH) is a severe inflammatory syndrome due to the excess activation of macrophages and T cells. Here, we report a case of melioidosis with

Case report:

A 50-year-old hypertensive and diabetic male patient presented with high-grade intermittent fever with loss of appetite and weight loss for two months and a history of jaundice, backache and swelling of both feet for 15 days. There was no history of cough, dyspnoea, distension of the abdomen, or dysuria. He had been on ayurvedic medication for diabetes for three years and had been taking antihypertensive treatment for four years. He was a school teacher by profession but involved in gardening

Discussion:

Melioidosis is transmitted from contaminated soil and water by aerosol inhalation, percutaneous inoculation and ingestion 5, 6. Drinking water, including public tap water, can be a source of melioidosis in highly endemic areas [6]. Agricultural workers are at high risk for developing melioidosis [7]. In our case the transmission might be due to contaminated soil from gardening activity. Melioidosis in human beings can be presented as acute, subacute, chronic, and subclinical septicaemia. In our

Declaration of Competing Interest:

The authors declare no conflicts of interest.

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