Polyarticular Septic Arthritis, Subcutaneous Abscesses, and Osteomyelitis Due to Burkholderia Cepacia in a Clinically Immunocompetent Patient: A Case Report and Literature Review

Burkholderia cepacia complex (BCC) infections are rare in immunocompetent individuals. Members of BCC are opportunistic pathogens most often found in patients with cystic fibrosis and chronic granulomatous disease, and immunocompromised patients such as patients with cancer or transplant recipients. BCC can cause chronic pulmonary infection; acute respiratory deterioration, such as cepacia syndrome in patients with cystic fibrosis; sepsis; pneumonia; urinary tract infections; and wound infections in immunocompromised hosts. However, very few cases of septic arthritis and osteomyelitis by this agent have been reported in literature. Here, a 48-year-old male without any clinical evidence of an immunocompromised status presented with pain and fluctuant swelling of multiple large and small joints for 4 weeks. Blood reports revealed anaemia and neutrophilia with raised inflammatory markers including erythrocyte sedimentation rate and C-reactive protein. X-rays of all involved joints showed destruction of articular surfaces of the corresponding bones with evidence of osteomyelitis. An ultrasonography revealed a 32×22 mm collection at the medial aspect of the left knee. Cultures of aspirated fluid from multiple joints yielded heavy growth of BCC. The patient was treated with intravenous ceftazidime and oral trimethoprim/sulfamethoxazole as per the susceptibility report. He also underwent multiple joint aspirations and rehabilitation. BCC-related septic arthritis and osteomyelitis is uncommon in immunocompetent patients, and cases reported in literature are monoarticular. This case highlights that BCC polyarticular septic arthritis with osteomyelitis and soft tissue abscesses is possible in a seemingly immunocompetent adult.