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

Authors:

U. V. V. Ranathunga ,

University of Colombo, LK
About U. V. V.
Department of Pathology, Faculty of Medicine
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L. J. De Silva,

University of Colombo, LK
About L. J.
Department of Pathology, Faculty of Medicine
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U. N. Wijenayake,

National Hospital of Sri Lanka, Colombo, LK
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A. Kaluarachchi,

National Hospital of Sri Lanka, Colombo, LK
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M. V. C. de Silva

University of Colombo, LK
About M. V. C.
Department of Pathology, Faculty of Medicine
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Abstract

Introduction: Melioidosis is an endemic infection in Southeast Asia, caused by a soil associated saprophyte bacterium Burkholderia pseudomallei. Melioidosis can affect any organ systems in the body. 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 Central Province presented with low-grade fever, abdominal pain and weight loss for one month. Initial investigations revealed high C-reactive protein (CRP) levels and neutrophil leucocytosis.  Blood and urine cultures were negative. Melioidosis antibodies were positive at a titre of 1:1280.  Except for a solid and cystic lesion in the left adnexa suggestive of an ovarian teratoma, extensive radiological evaluation did not reveal any infective focus.  She was treated with intravenous meropenem for four weeks, with which a transient improvement was observed. However, she was readmitted with high fever spikes and rising CRP two weeks after being discharged. The teratoma was suspected to harbour melioidosis infection and an oophorectomy was performed. Macroscopically, the ovarian mass showed 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 within the teratoma and within the glial elements in the peritoneum. Tissue Gram stain for bacteria and stains for fungi and mycobacteria were negative. The patient’s condition improved following oophorectomy and melioidosis serology became negative. 

 

Discussion and conclusion: The possibility of melioidosis infection within an ovarian teratoma was confirmed by the histological findings of suppurative inflammation, marked post-operative clinical improvement and melioidosis serology becoming negative post-operatively. Melioidosis is known to cause suppurative inflammation in deep organs, but gynaecological manifestations have been limited to 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.
How to Cite: Ranathunga, U.V.V., De Silva, L.J., Wijenayake, U.N., Kaluarachchi, A. and de Silva, M.V.C., 2021. Melioidosis complicating an ovarian teratoma with gliomatosis peritonei; a rare case with review of the literature on melioidosis affecting the gynaecological tract. Journal of Diagnostic Pathology, 16(2), pp.25–31. DOI: http://doi.org/10.4038/jdp.v16i2.7792
Published on 31 Dec 2021.
Peer Reviewed

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