A Case Report on Musculoskeletal Melioidosis

Melioidosis, caused by Burkholderia pseudomallei, is an underdiagnosed infection in India with a high case fatality rate if untreated. We report a case of a 59-year-old diabetic male farmer from West Bengal who presented with fever and respiratory distress. Initial empirical therapy with cefoperazone-sulbactam failed to improve his condition. Subsequently, he developed acute pain and swelling in the left shoulder. Imaging revealed osteomyelitis with intraarticular and periarticular abscesses. Surgical debridement and culture studies confirmed B. pseudomallei, identified using Ashdown’s medium, Gram staining, biochemical tests, and automated Vitek 2 analysis. The organism exhibited resistance to ceftazidime but was susceptible to meropenem and doxycycline. Despite initiation of targeted therapy, the patient took discharge against medical advice, preventing further outcome assessment. This case highlights the challenges of diagnosing melioidosis, particularly in rural settings where it mimics other tropical infections. Early suspicion, appropriate microbiological workup, and prompt initiation of effective antimicrobial therapy are crucial for improved outcomes. Greater clinician awareness and expanded diagnostic capacity are needed to prevent missed diagnoses and reduce mortality in endemic regions.