Latent Melioidosis Reactivation Following Immunosuppression in Malaysia: A Report of Two Cases

Melioidosis, caused by Burkholderia pseudomallei , is endemic in Southeast Asia. Over 90% of cases present acutely. The reactivation of latent melioidosis in endemic regions is difficult to diagnose, and the incidence is unknown. We report two previously healthy middle-age women from Limbang, Malaysian Borneo, who were newly diagnosed with systemic lupus erythematosus. They developed fulminant sepsis due to culture-confirmed melioidosis 4 to 8 weeks after starting immunosuppressive therapy. They had pneumonia and multiorgan microabscesses. One patient survived, whereas the other succumbed to illness. Diagnosing the reactivation of latent melioidosis in endemic regions is impeded by substantial gaps in clinical evaluation and laboratory diagnostic capacity, particularly within resource-limited health care systems. Maintaining high clinical vigilance for reactivation, promptly identifying disseminated disease, and initiating targeted therapy early are critical during the initiation and administration of immunosuppressive treatment. Pre-immunosuppression risk assessment and potential prophylactic strategies in high-risk individuals may help reduce the associated morbidity and mortality.