CONTEXT:
Melioidosis is endemic to tropical regions and, despite the common occurrence of
intra-abdominal abscesses, pancreatic involvement in melioidosis has not
previously been reported. OBJECTIVE: We report our experience with pancreatic
melioidosis.
PATIENTS:
All 65 patients treated for melioidosis who had computed tomography (CT) scans
were identified from prospective databases and were retrospectively reviewed.
MAIN OUTCOME MEASURES:
A detailed review of cases with pancreas involvement was carried out.
RESULTS:
There were four cases (three males and one female; median age 29.5 years, range:
25-48 years) with pancreatic melioidosis, giving a prevalence of 6.2%. All had
predisposing conditions (two had poorly controlled diabetes mellitus and two had
thalassemia) for melioidosis. Fever (100%), anorexia (100%), weight loss (100%),
rigor (75%) and abdominal pain (75%) were the most common symptoms at
presentation and the median duration of symptoms before presentation was six
weeks (range: 2-8 weeks). All pancreatic abscesses were detected on CT scan.
Multiple foci involvement was common (3 to 6 sites): blood (4 patients), liver
(3 patients), psoas muscle (2 patients), spleen (2 patients), infected ascites
(2 patients) and lung (1 patient). Pancreatic involvement ranged from
multi-focal micro-abscesses to focal large abscesses and involved all parts of
the pancreas (body 100%, head 75% and tail 50%). Associated pancreatic findings
included splenic vein thrombosis, peripancreatic inflammation and peripancreatic
fat streaking. All the pancreatic abscesses were resolved with antibiotics
without requiring pancreatic abscess drainage (including one patient who died
from disseminated melioidosis).
CONCLUSION:
Pancreatic involvement typically occurs as part of multi-organ involvement and
commonly manifests as multifoci micro-abscesses. Associated pancreatic
abnormalities were also common. All responded to treatment without requiring
drainage.
Correspondence:
VH Chong, Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran
Anak Saleha Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. email:
chongvuih@yahoo.co.uk
Article is available free
from http://www.joplink.net/
(Journal website).
