Systemic Melioidosis Presenting as Myocardial Infarct

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Abstract
A 58 year old soldier developed fever and precordial pain while serving in Viet Nam. The electrocardiogram disclosed "myocardial infarct". The febrile illness worsened for 70 days despite aggressive antibiotic add supportive therapy. Cultures were negative until Pseudomonas pseudomallei grew from sternal marrow a day after death. Autopsy revealed a full-thickness, left ventricular myocardial abscess and abscesses in skeletal muscle, brain, lungs, kidneys, prostate and liver. Abscesses were non-specific; necrotic debris and neutrophiles surrounded by neutrophiles and found cells, with little fibrous reaction. Epithelioid and multinucleated cells described by others were not present. Melioidosis results from infection by the gram negative bacillus Iji pseudomallei, which is indigenous to Southeast Asia. It is a medical problem of the Viet Nam conflict. Serologic evidence suggests widespread subclinical infection among the native population, but clinical disease, ranging from chronic to fulminant, may occur. The epidemiology, laboratory diagnosis, pathology, clinical features and therapy of melioidosis are discussed.