Somkanya Tungsanga M.D., Wittaya Wangsomboonsiri M.D, Somnuek Sungkanuparph M.D.


ABSTRACT

 We reported a case of melioidosis  who presented with long standing spondylodiscitis mimicking

tuberculosis. A 57-year-old Thai male farmer presented with chronic low back pain for one and a-half year.

Magnetic resonance imaging of lumbar spines revealed T12/L1 spondylodiscitis and bilateral psoas abscesses.

He was diagnosed as tuberculous  spondylodiscitis but failed to respond to a prolonged course of

antituberculous regimen. He had subsequently developed persistent abdominal pain at the left upper quadrant

and computed tomography scan showed multiple splenic microabscesses and progressive T12/L1

spondylodiscitis with more compression  fracture and enlarging psoas abscesses. Ultrasound-guided

percutaneous drainage of bilateral psoas abscesses was performed and purulent pus was aspirated from each

side. The pus and blood cultures grew Burkholderia pseudomallei. He was treated with a combination of oral

co-trimoxazole and intravenous ceftazidime with significant improvement. Among patients who present

with a long history of low back pain with evidence of spondylodiscitis, psoas and/or vertebral abscesses,

melioidosis should be aware of. Proper investigative procedureto identify etiologic organism can lead to the

correct and optimal treatment. (J Infect Dis Antimicrob Agents 2015;32:55-9.)

CASE REPORT

Keywords:Melioidosis, tuberculosis, Burkholderia pseudomallei, low back pain, spondylodiscitis, splenic

Corresponding author: Somnuek Sungkanuparph, M.D., Professor of Medicine, Division of Infectious Diseases, Department of Medicine, Ramathibodi

Hospital, 270 Rama 6 Road, Bangkok 10400, Thailand.

Email: somnuek.sun@mahidol.ac.th



 

 

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