Jun Cong LOW, Chee Yik CHANG
Infectious Diseases and Clinical Microbiology - 2026;8(1):102-103
A 60-year-old man with diabetes mellitus presented with a one-month history of fever and malaise. His medical history included benign prostatic hyperplasia, bilateral nephrolithiasis, and a horseshoe kidney. One month earlier, he had undergone an unsuccessful retrograde pyelogram and ureteric stenting for a left proximal ureteral stone. On admission, he was afebrile, and physical examination and chest radiography were unremarkable. Laboratory tests showed leukocytosis and elevated C-reactive protein. Urinalysis revealed pyuria with a negative nitrite test. Empirical intravenous piperacillin-tazobactam was commenced for presumed urinary tract infection. A computed tomography (CT) scan revealed a 2.5 x 3.5 x 3.0 cm abscess at the isthmus of the horseshoe kidney, with associated pyelitis. No prostatic abscess was identified. Urine culture subsequently yielded Burkholderia pseudomallei, confirming melioidosis, while blood cultures remained negative. The patient was treated with intravenous ceftazidime (2 g every 6 hours) for six weeks. A follow-up CT scan demonstrated a reduction in abscess size and resolution of pyelitis. He was discharged on oral co-trimoxazole with scheduled imaging follow-up.
