 Hello everyone! My name is Dr. Shikha Uday Prabhu Lavande. I am doing my 3rd year junior residency in the Department of Radio Diagnosis Goa Medical College. Today I am here to present a paper presentation before you titled, A Case Report on Radiological Manifestations of Meliodosis. Introduction. Meliodosis is a bacterial infection caused by Burkwood area pseudomalai seen predominantly in Southeast Asia and Northern Australia. It commonly infects the adults with an underlying predisposing health condition, mainly diabetes, malitis, chronic renal failure, alcoholism, malignancy, etc. Meliodosis has a wide spectrum of radiological manifestations. Almost every organ can get affected, but the most commonly affected organ is the lung, followed by the spleen and the liver. Diagnosis requires a high index of clinical suspicion in patients with septicemia or pyrexia of unknown origin living in or with a travel history to endemic areas. Case History. A 31-year-old male patient presented to the emergency department with a 5-day history of high-grade fever and severe abdominal pain. Patient had history of alcoholic liver disease and was a known type 1 diabetic on insulin for 6 years with poor control of diabetes. On examination, patient was fibril, hypotensive with tachycardia. Blood pressure normalized after fluid resuscitation. On peridominal examination, there was hepatospinomegaly with severe left hypochondriac tenderness. His laboratory investigations were performed, which revealed, hemoglobin level of 10 grams per deciliter, RBSL of 450 mg per cent. The total leukocyte count was elevated to about 25,000 per cubic millimetres, of which neutrophils comprised 86% and lymphocytes were 13%. ESR was 100, serum bilirubin, SGOT, SGPT, ALP were all raised, albumin globulin ratio was reversed, blood urea serum creatinine were normal. Patient was evaluated for dengue and malaria. The results were negative. No history of tuberculosis or COX contact was noted. Sputum AFP was negative. With this clinical background, the patient was subjected to radiological investigations that included chest x-ray and ultrasound dominant pelvis. This is a frontal radiograph of the chest, which in PA view, which reveal a well-defined radiopasty in the medastinum on the right side with its broad base towards the high lung. No air fluid levels or calcification noted with it. Lung fields were clear. No evidence of pleural effusion. Ultrasound of the abdomen revealed, hepatospinomegaly, multiple multi-loculated hypoechoic lesions of varying sizes were scattered throughout the liver and splenic parenchyma. This image shows you the spleen, which is definite of splenomegaly and shows hypoechoic lesions scattered in the upper pole as well as the lower pole with your perisplenic extension to the gastrosplenic ligament. These lesions showed minimal color uptake on Doppler evaluation. Trans-ibdominal ultrasound at segment 5 of the liver showed a hypoechoic lesion made up of multiple locus of varying sizes with minimal intralesional Doppler signals. The differential diagnosis of these hepatic and splenic lesions, including that of the thorax, the right medastinal radiopasty included tuberculosis and meliodosis. The patient was then subjected to CCT thorax and abdomen to characterize the lesions further. CCT abdomen revealed splenic abscesses with perisplenic extensions, which are described as follows. There was spleenomegaly with multi-loculated peripherally enhancing collections with internal enhancing septae at upper pole extending medially into the gastrosplenic ligament, abutting the tail of the pancreas and the body of the stomach. Superiorly, this collection extended into the subdiaphragmatic lesion. The collection of the lower pole extended inferiorly to come in close proximity to the splenic flexure of the colon. There was minimal perisplenic fat stranding noted. The splenic artery and the vein showed normal contrast to perspiration, ruling out or negating thrombosis. CCT of the liver at the level of main portal vein showed some lesions which had iso to hypodent center with small symmetric peripheral locutes arranged in radial fashion. This resembled the necklace pattern of this hepatic abscess. Another lesion showed a symmetric locutes of varying sizes with no extra-capsular extension. This was representing a honeycomb pattern of the liver abscess. In the thorax we saw patchy nodular airspace opacities in the apico-posterior segment of the left upper lobe and in the superior segment of the left lower lobe in subplural location. A cavitatory consolidation was noted in suprahyla location on the left side. Rest of the bilateral lung panchima was normal. In large heterogeneously enhancing necrotic lymph nodes were noted in the media standard. Further coming to the diagnosis and management, patient underwent laparotomy followed by splenectomy in view of the ruptured splenic abscess. The splenic abscess culture and the blood culture together revealed burgled area pseudomalide. Patient was diagnosed as a case of meliodosis with the background of blood culture, splenic abscess culture and supportive radiological findings. He was treated in the ICU for about two days with supportive therapy which included presence of inotropes for his persistent hypotension and antibiotic therapy. The patient succumbed in a span of few days owing to his septisemia. Coming to the discussion, meliodosis is an important public health bacterial infection that presents with a wide variety of clinical manifestations affecting lungs, plein, liver, kidneys and prostate. The most frequent presentation being fever with single or multiple abscesses. Imaging findings are not always specific and mimic other bacterial infections. It has a high mortality rate owing to the early spread of infection to the blood. There are different presentations of meliodosis as we have seen. So pulmonary meliodosis affects or manifests as consolidation, diffuse, nodular opacities which can involve the entire lung or cavatatory nodules confined to the upper lobes predominantly. Visceral meliodosis encompasses multiple hypoechoic multi-loculated abscesses in the liver, spleen, kidneys, prostate and ultrasound which show peripheral enhancement with internal enhancing septae if present on contrast enhanced CT scan of the lung. Concomitant liver and splenic abscesses or splenic abscess alone are also suggestive of meliodosis. CNS meliodosis range from normal CT or MRI findings to well-defined micro abscesses in frontal lobes and brainstem. Also included are micro abscesses, osteomyelitis, encephalitis and myelitis. Muscular skeletal system shows varied presentation in the form of osteomyelitis, soft tissue abscesses and rarely septic arthritis. The differential diagnosis represents bacterial, tubercular or fungal infections. In the conclusion, meliodosis is considered as a mimicar of melodies clinically and radiologically it may imitate tuberculosis, malignancy or any other disease hence described as a great mimicar. Definite diagnosis cannot be made on radiographic features alone but awareness of these manifestations can lead to early diagnosis in appropriate treatment. Diagnosis is mainly by a positive smear or culture, serological analysis by rising of indirect hemiglutination titers or a combination of both. These are my references. Thank you.