Isolated Adrenal Abscess Due to Melioidosis

Abstract

Melioidosis is a potentially life-threatening infectious disease that is endemic to tropical regions such as Southeast Asia and northern Australia. We report a case of melioidosis presenting as an isolated right adrenal abscess in an elderly woman with diabetes mellitus. The patient presented with fever and nonspecific abdominal pain, which was initially misdiagnosed as a urinary tract infection. Blood cultures identified Burkholderia pseudomallei, prompting further investigation using computed tomography, which revealed a multiloculated abscess in the right adrenal gland. Management included an intensive phase of intravenous ceftazidime combined with trimethoprim-sulfamethoxazole, followed by an eradication phase with oral trimethoprim-sulfamethoxazole. The patient showed clinical and radiologic improvement with antibiotic therapy alone. No clinical or biochemical evidence of adrenal insufficiency was observed. This case highlights the diagnostic and therapeutic challenges of adrenal melioidosis, emphasizing the need for early recognition, tailored antimicrobial therapy, and vigilant follow-up to prevent relapse and manage complications such as adrenal insufficiency.