Melioidosis and idiopathic pulmonary hemosiderosis: a cast-iron case

Melioidosis is an infection with clinical importance in northern Australia due to the high associated mortality despite appropriate therapy. This report presents a case of acute pulmonary melioidosis on a background remarkable for the absence of typical risk factors for infection, but the presence of a high iron pulmonary microenvironment consequent to idiopathic pulmonary hemosiderosis. In light of recent genetic analysis of Burkholderia pseudomallei, we postulate that the patient inadvertently provided a high-substrate environment for the iron-scavenging ability of B. pseudomallei's siderophore associated virulence factors, giving her a unique major risk factor for infection. This highlights the importance of considering individual patient factors in addition to population-wide risk factors in the differential diagnosis of a serious illness, and the value of genetic analysis of clinically significant pathogens.