PMC6145115_01
Blood agar: Smooth, tiny colonies initially which become chalky white after few days
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Fig1
Gram stain showed gram negative slender rods with bipolar staining, antibiotic susceptibility pattern gave clues to the microbiological diagnosis of Burkholderia pseudomallei, sensitive for ceftazidime and meropenem and resistant to gentamycin (Figs. 1 and 2).
MacConkey Agar: Pink or colourless colonies
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Fig2
Gram stain showed gram negative slender rods with bipolar staining, antibiotic susceptibility pattern gave clues to the microbiological diagnosis of Burkholderia pseudomallei, sensitive for ceftazidime and meropenem and resistant to gentamycin (Figs. 1 and 2).
a and b Axial view of Contrast Enhanced CT Abdomen and pelvis images showing cystic lesion with an enhancing wall suggesting abscesses in right psoas, iliacus muscles extending to gluteus muscles(white arrows)
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Fig3
A Contrast Enhanced CT scan (CE CT) of Chest, abdomen and pelvis showed multiple intramuscular abscesses over right psoas, iliacus, gluteus and obturator internus (the largest abscess measured 18 cm x 4 cm over right psoas and iliacus (Fig. 3)).
Coronal view of MRI sacroiliac joints: (during intensive phase treatment) a T1 Weighted Image showing thickening of right internal iliacus muscle(white arrow) and erosion of anterior joint space of right iliac joint(red arrow), b Fat supressed (STIR) image showing thickening of right internal iliacus muscle, oedema of fat planes anterior to right iliac bone and sacrum with extension into anterior joint space of right iliac joint(red arrow)
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Fig4
It also showed right sacroiliitis with surrounding marrow oedema and mild reactive bone changes (Fig. 4).
Coronal view of MRI sacroiliac joints: (following completion of intensive phase treatment) There is reduction of oedema over right internal iliacus muscle, iliac bone and sacrum with normal right sacroiliac joint(white arrow)
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Fig5
Follow up MRI Scan of sacroiliac joints done after 2 months showed marked reduction of infection, oedema and sacroiliitis and by that time, she was completely asymptomatic (Fig. 5).