Relapsing melioidosis presenting with native valve infective endocarditis: a rare case report

Melioidosis is caused by Burkholderia pseudomallei, with a broad clinical spectrum ranging from localized infections to fulminant sepsis. Cardiac involvement, particularly infective endocarditis (IE), is extremely rare. We report a 58-year-old patient with type 2 diabetes mellitus who initially presented with left knee septic arthritis and bacteremia due to Burkholderia pseudomallei. She was treated with intravenous ceftazidime followed by oral co-trimoxazole, with complete clinical resolution. Five months later, she represented with fever and recurrent knee swelling. Cultures again grew B. pseudomallei. Transthoracic and transesophageal echocardiography revealed vegetations on the aortic valve, confirming native valve infective endocarditis. She was treated with a prolonged course of intravenous ceftazidime and oral co-trimoxazole. Follow-up at one year after antibiotic cessation showed no evidence of recurrence. This case highlights relapsing melioidosis as a rare cause of native valve infective endocarditis and underscores the importance of long-term monitoring in patients with melioidosis. Although uncommon, cardiac involvement should always be considered and actively ruled out in cases of recurrent melioidosis.