A Prolonged Course of Hepatosplenic Melioidosis with Persistent Abscesses in Transfusion-Dependent β-Thalassemia Before Hematopoietic Stem Cell Transplantation: A Case Report
This case report describes the successful management of a 17-year-old patient with transfusion-dependent β-thalassemia and refractory hepatosplenic melioidosis through combined antimicrobial therapy and staged laparoscopic debridement, which ultimately enabled a safe hematopoietic stem cell transplantation without infection recurrence.
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In the humid, tropical regions of Southeast Asia, a silent and stubborn bacterium called Burkholderia pseudomallei lives in the soil and water. When it enters the human body through a cut in the skin or by breathing in contaminated dust, it causes an infection known as melioidosis. This disease is notorious for hiding deep inside the body, often forming pockets of pus called abscesses in vital organs like the liver and spleen. Because the bacteria can hide inside the body's own cells and within thick, fibrous walls, standard antibiotics often struggle to reach them, leading to infections that linger for years. The situation becomes even more precarious for people with certain blood disorders, such as beta-thalassemia. These individuals rely on regular blood transfusions to survive, but this treatment can lead to a dangerous buildup of iron in the body. This excess iron weakens the immune system, making it harder for the body to fight off invaders like melioidosis. For doctors, the challenge lies in knowing how to clear these deep-seated infections in patients who are already fragile, especially when those patients need a major medical procedure like a stem cell transplant, which temporarily shuts down the immune system to accept new cells.
A team of doctors in China recently shared the story of a seventeen-year-old boy who faced this exact struggle, offering a roadmap for how to handle such difficult cases. The patient, who had lived in Hainan Province—an area where this tropical infection is common—had been diagnosed with severe beta-thalassemia at just one year old. For sixteen years, he relied on regular blood transfusions, which eventually caused his body to accumulate too much iron. By the time he was ten, doctors had already found abscesses in his liver and spleen, but they did not know what was causing them. For nearly four years, the boy suffered from recurring high fevers and worsening internal damage. The abscesses grew larger, began to affect nearby blood vessels, and even spread to his bones, causing chronic bone inflammation. Despite trying various strong antibiotics, the infections refused to go away, and the boy's condition continued to deteriorate.
The turning point came in 2022 when the medical team finally identified the culprit. By using a needle to draw fluid from one of the liver abscesses and analyzing it with advanced sequencing tools, they confirmed the presence of Burkholderia pseudomallei. With the diagnosis finally clear, the doctors began a rigorous course of treatment. They started with powerful intravenous antibiotics, including a drug called ceftazidime, and later switched to other combinations like imipenem and doxycycline. However, even after months of this intensive drug therapy, the abscesses did not disappear. The bacteria had become trapped inside thick, fibrous capsules that the drugs could not penetrate effectively. The boy still had fever and active lesions, making it too dangerous to proceed with his planned stem cell transplant, which would have left him vulnerable to a fatal recurrence of the infection.
Recognizing that medicine alone was not enough, the team decided to take a surgical approach, but they did so in careful stages. In early 2023, the boy underwent a laparoscopic surgery, where surgeons used small cameras and instruments to remove part of his spleen and a wedge of his liver. This was a cautious first step because his liver was damaged and his blood pressure in the liver veins was dangerously high, making a full removal risky. After this surgery, he continued on antibiotics for nearly a year. During this time, the remaining abscesses slowly shrank and became more contained. By early 2024, the doctors felt confident enough to perform a second surgery. This time, they removed the rest of the spleen and cleared out the remaining pockets of infection in the liver. Following this second operation, the boy's body showed no signs of active infection; the only things left were small, harmless calcium deposits where the abscesses used to be.
With the infection fully under control, the boy finally received his allogeneic hematopoietic stem cell transplant in 2024, a procedure where he received healthy blood-forming cells from a donor. The surgery and the careful management of his infection paid off. During the recovery period and in the months that followed, he did not suffer a recurrence of the melioidosis, despite the intense immunosuppression required for the transplant. This case highlights a critical lesson for doctors treating similar patients: when a person with a blood disorder and iron overload develops stubborn abscesses in the liver or spleen, it is vital to test for melioidosis early. If antibiotics fail to clear the infection, waiting too long can cause permanent organ damage. Instead, a combination of targeted surgery to remove the hidden pockets of bacteria and careful timing before a transplant can offer a path to a cure. The success of this young patient suggests that for those with deep-seated, encapsulated infections, removing the physical source of the bacteria is often just as important as killing the bacteria with drugs.
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