Chronic Melioidosis Mimicking Tuberculosis
Somkanya Tungsanga M.D., Wittaya Wangsomboonsiri M.D, Somnuek Sungkanuparph M.D.
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.)
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.
Keyword : Melioidosis, tuberculosis, Burkholderia pseudomallei, low back pain, spondylodiscitis, splenic
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