Rare Case of Non-Resolving Bilateral Pneumonia with Septic Arthritis and Osteomyelitis

Abstract The diagnosis of melioidosis can be challenging due to its varied clinical presentation and its close resemblance to bacteria belonging to the genus pseudomonas. This case report detailed the clinical progression of a 38-year-old male patient diagnosed with diabetes who presented to our facility with intermittent fever, left knee pain, swelling in the lower limb for 20 days, and shortness of breath for one week. Initial CT and MRI imaging confirmed the presence of bilateral pneumonia and left knee arthritis with lower femur osteomyelitis. Acid fast bacilli (AFB) stain and aerobic culture test with left knee synovial fluid showed negative for tuberculosis. The blood culture demonstrated the presence of B. pseudomallei growth. The confirmation of positive blood culture for B. pseudomallei, in conjunction with the identification of radiological findings, firmly established the diagnosis of this uncommon disease in our case. Consequently, the patient was initiated on a treatment regimen of meropenem injections, followed by a course of trimethoprim-sulphamethoxazole for two weeks, and anticoagulant therapy for deep vein thrombosis (DVT). After a two-week hospital stay, the patient was discharged and continued treatment with trimethoprim-sulphamethoxazole and anticoagulants for a duration of three months. Subsequent follow-up confirmed the patient's complete recovery with no signs of recurrence.