An Atypical Obstetric Presentation of Melioidosis as a Tubo-ovarian Abscess in the Postpartum Period

challenges when cultures are negative and demonstrates the important role of MALDI-TOF MS in establishing a diagnosis and guiding appropriate antibiotic therapy in an endemic area. IntroductIonMelioidosis has increasingly been recognized as a cause of severe sepsis and abscesses in many tropical and subtropical regions, with an estimated global burden of around 165,000 cases and 89,000 deaths annually. 1India contributes substantially to this burden, with studies suggesting 20,000-52,000 cases a year and a high prevalence in a few coastal states such as Tamil Nadu and Puducherry. 2 The environmental isolation of Burkholderia pseudomallei from soil and water in South Indian states reveals the presence of established endemic foci, and the epidemiological studies done indicate a high level of exposure in the local population. 3The organism usually infects humans through percutaneous inoculation, inhalation, or ingestion and can present as localized abscesses, pneumonia, or fulminant sepsis. 1 Gynecologic involvement, however, especially tubo-ovarian abscess (TOA), remains extremely rare, with only isolated cases described in the literature.Of exceptional clinical significance, the overwhelming majority of reported gynecological melioidosis cases have culminated in fatal outcomes or occurred in the context of disseminated multiorgan disease. 4his case report describes a postpartum TOA caused by B. pseudomallei infection in an otherwise healthy woman in the absence of typical risk factors.