Severe Melioidosis During Chemotherapy for Metastatic Breast Cancer

What happened, in summary

A 58-year-old woman with metastatic breast cancer was receiving chemotherapy when she developed a high fever, worsening shortness of breath, cough, and severe reductions in her blood counts. She had completed 4 cycles of Adriamycin with cyclophosphamide followed by 2 cycles of paclitaxel and carboplatin. Blood and sputum cultures identified melioidosis, a serious bacterial infection, and she also developed septic arthritis in her right knee.

Despite antibiotics and supportive treatment, the infection remained difficult to control. Because she had chemotherapy-related immune suppression and persistent infection, her doctors used a low dose of nivolumab as an experimental rescue treatment for the infection, not as part of her breast-cancer therapy. Her fever burden fell, blood counts improved, and she was able to come off oxygen, although blood cultures initially remained positive.

The antibiotic regimen was then intensified, after which her fever resolved and blood cultures became negative. She was discharged on oral antibiotics with outpatient follow-up.