Chronic osteomyelitis of the femur caused by Burkholderia pseudomallei in a patient with type 2 diabetes mellitus

Abstract

Melidiosis is a life-threatening infectious disease, and the causative organism is Burkholderia pseudomallei. It occurs as an environmental saprophyte in endemic regions of northern Australia and Southeast Asia. A 43-year-old male patient known to have type 2 diabetes mellitus, presented with fever, thigh swelling. He had received treatment with multiple antimicrobial agents, including antituberculosis drugs, but no improvement was observed. An incision and drainage of medullary canal was done and pus culture grew Burkholderia pseudomallei. He was managed with intravenous meropenem followed by oral cotrimoxazole. A high index of suspicion is required for early diagnosis. Burkholderia pseudomallei infection should be suspected in patients with diabetes mellitus, in patients presenting with an abscess not responding to antimicrobial treatment, especially in patients from endemic areas. The organism responds only to specific antibiotics; therefore correct and timely diagnosis becomes crucial for a better outcome.