Melioidosis as a cause of femoral osteomyelitis and multifocal intramuscular abscess around the hip joint in a farmer: a case report

• Main Authors: KMD Rodrigo, R Premaratna, HJ de Silva, E Corea
• Format: Article
• Language: English
• Published: Sri Lankan Society for Microbiology 2013-02-01
• Series: Sri Lankan Journal of Infectious Diseases
• Subjects: burkholderia pseudomallei, melioidosis, osteomyelitis
• Online Access: https://sljid.sljol.info/articles/4655

<p>Melioidosis is a potentially fatal infectious disease caused by the soil transmitted saprophyte <em>Burkholderia pseudomallei. </em>Though Sri Lanka being considered a non endemic country, with the increasing number of cases reported recently there is mounting evidence that the disease is emerging here. Osteomyelitis caused by <em>Burkholderia psuedomallei</em> infection is uncommon and only few cases were found in the literature. We report a case of proximal femoral osteomyelitis and multifocal intramuscular abscess around the hip joint caused by <em>Burkholderia psuedomallei</em> in a Sri Lankan farmer. A 57 year old Sinhalese male farmer was admitted with intermittent high grade fever and left hip pain for 3 weeks. He was found to have diabetes. Ultrasound scan of the left hip joint revealed a joint effusion of 1 cm. Whole body anterior and posterior delayed images of a Tc-99m MDP bone scan demonstrated intense tracer uptake in the left proximal femur and the CT pelvis revealed a left side multi focal intramuscular abscess around the hip joint and proximal femur osteomyelitis. The CT guided aspiration of the intramuscular abscess fluid yielded a growth of gram negative bacilli, identified as pseudomonas species. Blood for antibodies for <em>Burkholderia psuedomallei </em>revealed a positive result at a titre of 1:320. He was diagnosed as having probable melioidosis with multifocal intramuscular abscess around the left hip joint and left proximal femoral osteomyelitis. He responded to intravenous meropenem 1 g twice a day and was continued for 4 weeks and was discharged on maintenance regime of oral cotrimoxazole 1920 mg twice a day and oral doxycycline 100 mg twice a day for 20 weeks. Our patient remained asymptomatic after 6 months of follow up and a subsequent ultrasound and CT images showed full resolution of the osteomyelitis and failed to demonstrate any abscess formation. This case alerts clinicians regarding the unusual aetiology of osteomyelitis caused by <em>Burkholderia psuedomallei</em> especially in patients with diabetes and those who have prolonged contact with soil. In such situations early institution of appropriate antibiotics will be life saving and a prolonged maintenance therapy with oral antibiotics is essential to prevent recrudescence of the infection.</p><p><span lang="EN-GB" style="line-height: 115%; font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-GB; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">DOI: <a href="http://dx.doi.org/10.4038/sljid.v3i1.4655"><span style="color: #0000ff;">http://dx.doi.org/10.4038/sljid.v3i1.4655</span></a></span></p>