Case Report Dealing with the honey trap: a case of hepatic melioidosis M. Harsha 1 , T. Praveen Kumar 1,* , M. Varma 1 and C. Mukhopadhyay 2 1 Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India 2 Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India * Address correspondence to Dr T. Praveen Kumar, Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India. email: praveenkuma.124@gmail.com Learning points for clinicians 1) Uncontrolled diabetes is a common and significant risk factor for melioidosis. 2) In endemic areas with host risk factors, melioidosis should be strongly considered in the presence of a honey- comb liver abscess. 3) Surgical drainage may be considered as salvage therapy for a melioidosis liver abscess that is unresponsive to medical treatment. Case report A 36-year-old man from Kerala presented with 15 days of high- grade fever with chills and right hypochondrial pain for 4 days. On admission, he was hemodynamically stable and initial blood work revealed neutrophilic leukocytosis (total leukocyte count— 10 500 cells/mm 3 , neutrophils 81%), abnormal liver function test (bilirubin—1.7 mg/dl, alanine transaminase—214 IU/l aspartate transaminase—113 IU/l), hyponatremia (sodium—126 mmol/l), and he was diagnosed to be de novo diabetes mellitus type 2 (HBA1C—9.2%). Computed tomography showed a multiloculated and multiseptated honeycomb abscess suggestive of possible melioidosis (Figure 1A). Subsequently, blood culture also revealed Burkholderia pseudomallei (Figure 1B). After confirmation of the diagnosis, the patient was treated with meropenem (1 g every 8 h intravenously), and his blood glu- cose was controlled with insulin and oral hypoglycemic agents. Despite appropriate therapy, his febrile episodes persisted be- yond a week. A repeat blood culture performed after a week of appropriate antibiotic therapy showed B.pseudomallei growth. Because of the multiloculated and multiseptated nature of the liver abscess, pig tail drainage was not feasible. Combination an- tibiotic therapy with co-trimoxazole was considered, but despite Figure 1. (A) Multiseptated honeycomb liver abscess (arrow) in segment VI of liver. (B) Purple colored wrinkled colonies of Burkholderia pseudomallei in Ashdown’s media. Received: 06 July 2023. VC The Author(s) 2023. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com QJM: An International Journal of Medicine, 2023, 00(0), 1–2 https://doi.org/10.1093/qjmed/hcad175 Advance Access Publication Date: 18 July 2023 Case Report Downloaded from https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcad175/7225865 by guest on 28 July 2023