Hemophagocytic Lymphohistiocytosis Complicating Melioidosis

A 50-year-old Caucasian female living in remote northern Australia presented to hospital with a 2-day history of lower limb pain, back pain, and confusion. Her past medical history was notable for hazardous alcohol use and an aortic valve replacement 3 months previously. A chest X-ray revealed right upper lobe consolidation and she received empirical intravenous meropenem and azithromycin. She rapidly deteriorated and required intubation for respiratory failure. Blood cultures collected on admission subsequently grew Burkholderia pseudomallei, confirming a diagnosis of melioidosis.