A rare and fatal case of tubo-ovarian abscess due to Burkholderia pseudomallei presenting as puerperal sepsis

Introduction: Melioidosis is an emerging life threatening  infectious disease caused by Gram negative bacilli  Burkholderia pseudomallei  found in contaminated soil and surface ground water .  It often presents with varied clinical manifestations and has a high mortality if left untreated due to lack of clinical suspicion. Here we report a rare and fatal case of puerperal sepsis due to  Burkholderia pseudomallei  in a young woman. Case report:  A 25-year-old female comes to a medical consultation at day 43 post partum with complains of fever on and off for the past 40 days associated with vomiting. On per speculum examination, greenish discharge from the cervix was seen and a right adnexal mass was felt which was cystic in consistency, non-tender and pushing cervix to the left side. Exploratory laparotomy was carried out and pus was drained from below the rectus sheath, and from right tubo-ovarian mass. Peripheral blood sample and the pus samples collected intraoperatively grew  Burkholderia pseudomallei . The patient expired on the 5 th  post operative day due to septic shock with disseminated intravascular coagulation  secondary to puerperal sepsis.  Conclusion:  Melioidosis is a fatal but treatable disease when it is promptly diagnosed. In a country like India, where tuberculosis is highly endemic, underdiagnosis of melioidosis can be a common consequence. Clinicians and Microbiologists should have high index of suspicion especially in individuals with underlying illness.