Melioidosis Presenting As a Chronic Splenic Abscess: A Diagnostic Challenge.

Melioidosis is a potentially fatal infection caused by Burkholderia pseudomallei, often presenting as various clinical manifestations and is commonly misdiagnosed in endemic regions, leading to delayed diagnosis. We report the case of a middle-aged female patient with uncontrolled diabetes mellitus and occupational exposure as a farmer, who presented with chronic fever and abdominal pain of one year duration. She had a prior history of a treated lumbar abscess where microbiological diagnosis was missed. Imaging revealed a multiloculated splenic abscess with features of impending rupture. Possible differentials of tuberculosis, infective endocarditis, and brucellosis were excluded through detailed evaluation. Splenectomy was performed due to the high risk of impending rupture. Microbiological analysis of splenic tissue confirmed B. pseudomallei. The patient was treated with intravenous meropenem followed by eradication therapy with cotrimoxazole and had a good clinical recovery. This case highlights the importance of considering melioidosis in chronic visceral abscess, especially in diabetic patients with environmental exposure.