Melioidosis with endocarditis and massive cerebral infarct

Endocarditis due to melioidosis is rare. A 60-year-old male was admitted with upper abdominal pain and vomiting for one month. Contrast enhancing computed tomography (CT) of the abdomen showed multiple hepatic, splenic and pancreatic nonenhancing cystic lesions. Culture of CT guided aspirate from the liver lesion showed growth of Burkholderia pseudomallei. He was started on ceftazidime and cotrimoxazole. Four days after admission patient developed decreased speech and response. Magnetic resonance imaging (MRI) and MR angioram brain showed massive infarct in the middle cerebral artery territory and occlusion of the middle cerebral artery. Echocardiogram showed vegetation in the aortic valve. He was diagnosed to have disseminated melioidosis with endocarditis resulting in massive infarct in the middle cerebral artery territory.