A Rare Presentation of Genitourinary Melioidosis: Isolation of Burkholderia pseudomallei From a Prostatic Abscess in a Patient From Puducherry

Melioidosis, caused by the facultative intracellular Gram-negative bacterium <i>Burkholderia pseudomallei</i>, presents with diverse clinical manifestations ranging from asymptomatic carriage to life-threatening infections. We report a rare case of genitourinary melioidosis presenting as a prostatic abscess in a 70-year-old male patient with chronic kidney disease from southern India. The patient presented with fever, breathlessness, and scrotal swelling. Imaging revealed multiple prostatic abscesses with urine cultures growing <i>B. pseudomallei</i>, confirmed by biochemical tests and automated identification systems. The patient was empirically treated with IV clindamycin (600 mg q8h) and IV piperacillin-tazobactam (4.5 gm q8h) along with inotropes and fluids. Timely confirmation of genitourinary melioidosis led to escalation of antibiotics to IV ceftazidime 2 gm q6h for four weeks, followed by oral trimethoprim-sulfamethoxazole for three months, leading to complete clinical and microbiological recovery. This case highlights the importance of early recognition and accurate microbiological diagnosis of <i>B. pseudomallei</i> in atypical presentations to ensure timely and effective therapy, especially in endemic regions and in patients with risk factors such as chronic kidney disease.