ArticleJACC. Case reports2025
Disseminated Melioidosis Complicated by Right-Sided Infective Endocarditis: A Rare Case of Pulmonary Valve Involvement.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMelioidosis caused by gram-negative bacilli, Burkholderia pseudomallei, can present with a wide range of illnesses, from pneumonia and cutaneous infection to disseminated disease with severe septicemia. CASE SUMMARY: A 55-year-old man with newly diagnosed diabetes presented with fever and productive cough. Chest radiograph showed right-sided lobar pneumonia. Blood cultures, endotracheal tube culture and sensitivity testing, and bronchoalveolar lavage confirmed a diagnosis of disseminated melioidosis. Transesophageal echocardiography showed a large, 4.8 × 1.28 cm mass at the pulmonary valve, another mass at the tricuspid valve, and inferior vena cava thrombus. Left ventricular ejection fraction was significantly reduced (21%). These findings were suggestive of right-sided infective endocarditis. The patient was treated medically with intravenous meropenem, gentamicin, vancomycin and trimethoprim-sulfamethoxazole for 6 weeks, and anticoagulation was started, leading to complete resolution of the vegetation and clot. DISCUSSION: We present a rare case of right-sided infective endocarditis involving the pulmonary valve secondary to B pseudomallei. TAKE-HOME MESSAGE: Early recognition and prompt antimicrobial treatment are crucial in right-sided infective endocarditis secondary to melioidosis, which often presents with predominant respiratory symptoms and requires a high index of suspicion.
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