Acute Disseminated Melioidosis Presenting with Septic Arthritis and Diffuse Pulmonary Consolidation in an Otherwise Healthy Adult: A Case Report

Authors

  • Hai Sherng Lee Monash University, Malaysia.
  • Abdul Azeez Ahamed Riyaaz Monash University, Malaysia.
  • Seng Hong Yeoh Monash University, Malaysia.

DOI:

https://doi.org/10.5195/ijms.2015.118

Keywords:

Abscess, Adult, Arthritis Infectious, Burkholderia pseudomallei, Melioidosis

Abstract

Background: Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is most prevalent in South-East Asia, northern Australia, and the Indian subcontinent. Septic arthritis is a rare manifestation of melioidosis. Melioidosis is usually found in patients with diabetes, heavy alcohol use, or chronic lung disease.

Case: We report a case of melioidosis in an otherwise healthy 44-year-old male, who presented with acute painful left knee swelling, high-grade fever associated with chills, rigors and night sweats, and a productive cough. Examination revealed active synovitis with effusion involving his left knee, ankle and elbow joints and scattered crackles over both lung fields. Chest X-ray showed diffuse pulmonary consolidation. Abdominal ultrasound showed splenic micro-abscesses. The diagnosis was made based on a positive blood culture for Burkholderia pseudomallei. He was started on appropriate antibiotics and responded well, becoming afebrile after 48 hours, while his joint effusions disappeared after one week.

Conclusion: Septic arthritis only occurs in 4% of patients with melioidosis. When there is diffuse pulmonary involvement, melioidosis may mimic disseminated tuberculosis, sepsis syndromes, and systemic vasculitis syndromes. This case is relevant for medical literature as melioidosis is emerging and is expanding its territories worldwide. It should be considered early in the differential diagnoses in endemic areas so that treatment can be started early to reduce its high mortality and morbidity.

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Author Biography

Hai Sherng Lee, Monash University, Malaysia.

Dr Hai Sherng Lee is currently working at the Wollongong Hospital in New South Wa¬les, Australia. He graduated from Monash University and was awarded, in his final year, “Excellence in Pre-Intern Assessment” un¬der the Acute General Sur¬gery Unit at the School of Clinical Sciences, Monash Health, Victoria, Australia.

References

1. Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012 Sep 13;367(11):1035-44.
2. Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis. 2010 Nov 30;4(11):e900.
3. Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, et al. Increasing incidence of human melioidosis in Northeast Thailand. Am J Trop Med Hyg. 2010 Jun;82(6):1113-7.
4. Pagalavan L. Melioidosis: the Johor Bahru Experience. Med J Malaysia. 2005 Dec;60(5):599-605.
5. Peacock SJ, Schweizer HP, Dance DA, Smith TL, Gee JE, Wuthiekanun V, et al. Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei. Emerg Infect Dis. 2008 Jul;14(7):e2.
6. Richardson LJ, Kaestli M, Mayo M, Bowers JR, Tuanyok A, Schupp J, et al. Towards a rapid molecular diagnostic for melioidosis: comparison of DNA extraction methods from clinical specimens. J Microbiol Methods. 2012 Jan;88(1):179-81
7. Wuthiekanun V, Chierakul W, Langa S, Chaowagul W, Panpitpat C, Saipan P, et al. Development of antibodies to Burkholderia pseudomallei during childhood in melioidosis-endemic northeast Thailand. Am J Trop Med Hyg. 2006 Jun;74(6):1074-5.
8. Chetchotisakd P, Chierakul W, Chaowagul W, Anunnatsiri S, Phimda K, Moot¬sikapun P, et al. Trimethoprim-sulfamethoxazole versus trimethoprim-sulfa-methoxazole plus doxycycline as oral eradicative treatment for melioidosis (MERTH): a multicentre, double-blind, non-inferiority, randomised controlled trial. Lancet. 2014 Mar 1;383(9919);807-14.
9. Cheng AC, Chierakul W, Chaowagul W, Chetchotisakd P, Limmathurotsakul D, Dance DA, et al. Consensus guidelines for dosing of amoxicillin-clavulana¬te in melioidosis. Am J Trop Med Hyg. 2008 Feb;78(2):208-9.
10. Limmathurotsakul D, Chaowagul W, Chierakul W, Stepniewska K, Mahar¬jan B, Wuthiekanun V, et al. Risk factors for recurrent melioidosis in nor¬theast Thailand. Clin Infect Dis. 2006 Oct 15;43(8):979-86

Published

2015-03-30

How to Cite

Sherng Lee, H., Ahamed Riyaaz, A. A., & Hong Yeoh, S. (2015). Acute Disseminated Melioidosis Presenting with Septic Arthritis and Diffuse Pulmonary Consolidation in an Otherwise Healthy Adult: A Case Report. International Journal of Medical Students, 3(1), 59–62. https://doi.org/10.5195/ijms.2015.118

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Case Report

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