Disseminated Melioidosis Presenting as Thoracic Empyema and Splenic Abscess — A Case Report and Review of Literature

Introduction – This case highlights an unusual and challenging presentation of disseminated melioidosis in a high-risk patient from a rural, endemic area of the Philippines. The coexistence of splenic abscesses, thoracic empyema, tuberculous pleuritis, and prior breast cancer complicated the diagnosis. Main Findings – A 55-year-old woman with diabetes, chronic kidney disease, and a history of breast cancer presented with a prolonged fever, difficulty breathing, and weight loss. Imaging revealed fluid buildup around the lungs and several abscesses in the spleen. She was initially misdiagnosed with dengue and suspected of having tuberculosis. Management and Outcomes – Cultures confirmed Burkholderia pseudomallei. She received IV meropenem, then oral co-amoxiclav, with image-guided splenic drainage and intrapleural fibrinolysis. Tuberculosis and malignancy management were coordinated, leading to clinical and radiologic improvement. Conclusion – In endemic regions, clinicians should suspect melioidosis when diagnosing systemic infections, especially in patients with diabetes or chronic kidney disease. Prompt microbiologic confirmation and a multidisciplinary team are crucial for managing atypical cases.