Adjunctive nivolumab in combination with antibiotic therapy for the management of refractory melioidosis in a patient with metastatic breast cancer and chemotherapy-induced pancytopenia

Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to multiple classes of antibiotics and primarily affects immunocompromised individuals, such as those with poorly controlled diabetes or malignancies. In this case, a 58-y-old female farmer with poorly controlled diabetes (HbA1c of 11.4%), metastatic breast cancer with chemotherapy-induced pancytopenia and disseminated melioidosis showed no improvement despite receiving antibiotics and supportive care. However, the introduction of adjunctive nivolumab, combined with an antibiotic regimen, resulted in significant therapeutic benefit, suggesting a promising new approach for managing severe and refractory melioidosis.