Intraoperative Cardiovascular Emergency in Spinal Melioidosis Presenting as a Case of Spinal Epidural Abscess: A Rare Case Study of 2 Patients

Melioidosis rarely presents with spinal involvement, which may lead to neurological complications. It's endemic to Thailand and Australia, but rare in India. Patients with diabetes, immunocompromised states, and chronic renal failure are at high risk of developing melioidosis, which can present with localized or disseminated abscess collection. We reported two patients. One was a 37-year-old male with Type 2 Diabetes Mellitus who was transported to D10 SEA with a Paraspinal collection at L2-L4, but without vertebral body involvement. The other patient was a 64-year-old male with Type 2 Diabetes Mellitus who had Grade 2 spondylolisthesis L5S1 with sacroiliitis. Both patients underwent minimally invasive decompression, and the second patient also received unilateral fixation. We sent the materials for histopathology, biopsy, pus c/s, fungal c/s, Genexpert, gram stain, and AFB stain. However, both patients developed hypotensive shock intraoperatively and were monitored in the ICU. Meliodosis is a rare disease in the Indian subcontinent that can manifest as a spinal epidural abscess with spondylodiscitis. It is important to consider this disease in immunocompromised, diabetic, or chronically renal diseased patients. Adequate intraoperative and postoperative management is crucial to prevent mortality.