Melioidosis complicating an ovarian teratoma with gliomatosis peritonei; a rare case with review of the literature on melioidosis affecting the gynaecological tract

[摘要] Introduction: Melioidosis is an endemic infection in Southeast Asia, caused by a soil associatedsaprophyte bacterium Burkholderia pseudomallei. Melioidosis can affect any organ systems in thebody. This is a very rare case of an ovarian teratoma complicated by melioidosis.Case report: A 38-year-old woman, who had a recent travel history to India and the North CentralProvince presented with low-grade fever, abdominal pain and weight loss for one month. Initialinvestigations revealed high C-reactive protein (CRP) levels and neutrophil leucocytosis. Blood andurine cultures were negative. Melioidosis antibodies were positive at a titre of 1:1280. Except for asolid and cystic lesion in the left adnexa suggestive of an ovarian teratoma, extensive radiologicalevaluation did not reveal any infective focus. She was treated with intravenous meropenem for fourweeks, with which a transient improvement was observed. However, she was readmitted with highfever spikes and rising CRP two weeks after being discharged. The teratoma was suspected to harbourmelioidosis infection and an oophorectomy was performed. Macroscopically, the ovarian massshowed a solid, firm, gritty cut surface with cystic areas. Microscopy revealed an immature teratoma(grade-II) with evidence of gliomatosis peritonei. There were areas of suppurative inflammation withinthe teratoma and within the glial elements in the peritoneum. Tissue Gram stain for bacteria andstains for fungi and mycobacteria were negative. The patient’s condition improved followingoophorectomy and melioidosis serology became negative.Discussion and conclusion: The possibility of melioidosis infection within an ovarian teratoma wasconfirmed by the histological findings of suppurative inflammation, marked post-operative clinicalimprovement and melioidosis serology becoming negative post-operatively. Melioidosis is known tocause suppurative inflammation in deep organs, but gynaecological manifestations have been limitedto a few case reports, including tubo-ovarian abscesses, pelvic inflammatory disease and cervicitis.This is the first case reported as involvement of an ovarian teratoma.

[学科分类] 生理学与病理学

[关键词] ovary;teratoma;melioidosis;abscess;suppurative inflammation