Disseminated melioidosis presenting with multifocal thoracic aortic mycotic aneurysms: A case report

Abstract

BACKGROUND

Melioidosis, caused by Burkholderia pseudomallei (B. pseudomallei), is endemic to Southeast Asia and northern Australia, with clinical manifestations ranging from localized infection to life-threatening disseminated disease. Mycotic aneurysm is a rare but serious complication of disseminated melioidosis, associated with high morbidity and mortality.

CASE SUMMARY

We describe a case of a 67-year-old man with diabetes mellitus who presented with B. pseudomallei bacteremia complicated by multiple deep-seated abscesses and multifocal mycotic aneurysms of the descending thoracic aorta. Despite appropriate antimicrobial therapy, serial imaging demonstrated progressive aneurysmal enlargement. Surgical repair was recommended but declined by the patient. He was managed conservatively with prolonged antimicrobial therapy and close clinical and radiological monitoring.

CONCLUSION

This case illustrates the aggressive nature of disseminated melioidosis with vascular involvement and highlights the need for early diagnosis and multidisciplinary management to improve outcomes.

Keywords: Splenic abscess; Descending aorta; Mycotic aneurysm; Burkholderia pseudomallei; Melioidosis; Case report

Core Tip: Melioidosis is a potentially severe infectious disease caused by Burkholderia pseudomallei, with clinical manifestations ranging from localized infection to fulminant disseminated disease. Although vascular involvement is an uncommon complication, mycotic aneurysm represents a particularly severe manifestation. Involvement of the thoracic aorta is especially rare and carries a high risk of morbidity and mortality. This case highlights disseminated melioidosis complicated by multifocal mycotic aneurysms of the descending thoracic aorta, emphasizing the need for early recognition, serial imaging, and multidisciplinary management to improve patient outcomes.