Ulceronecrotic Eschar as a Cutaneous Clue to Disseminated Melioidosis

Melioidosis is a potentially fatal infection caused by Burkholderia pseudomallei that is often underdiagnosed because of its diverse clinical presentations. We report the case of a 49-year-old female farmer from Tamil Nadu who presented with a 10-day history of fever, productive cough, and breathlessness followed by a rapidly progressive ulceronecrotic lesion on the forehead for 6 days. Examination revealed a 3 × 2 cm crusted eschar with surrounding edema. Blood, pus swab, and tissue bit grew B. pseudomallei, and imaging showed multiple abscesses in the lungs, liver, spleen, and brain. She was newly diagnosed with diabetes (hemoglobin A1c: 9.2%) and treated with intravenous meropenem, but she succumbed to refractory septic shock. This case highlights the need to recognize atypical cutaneous signs as early indicators of disseminated melioidosis, especially in endemic regions, and the importance of timely, appropriate antibiotic therapy.