Disseminated Melioidosis from a Ruptured Infective Aortic Aneurysm and Pedal Ulcers to Septic Arthritis and Osteomyelitis: A Case Report.

Burkholderia pseudomallei (BP) is a gram-negative bacterium that causes melioidosis. Prolonged infection can lead to dissemination with rare presentations. A 65-year-old male presented with worsening back pain, persistent fever, and bilateral infected pedal ulcers. Four months previously, he had been treated for fever of unknown origin. Computed tomography (CT) aortography revealed a 63×54 mm saccular infrarenal aneurysm. Blood cultures revealed BP sensitive to cephalosporins and carbapenems. The patient underwent emergency surgical repair. Postoperatively, fever persisted, and he developed right knee pain and ankle swelling. Positron emission tomography (PET)-CT revealed further dissemination, leading to osteomyelitis and septic arthritis. Antibiotic therapy was changed, and the symptoms improved. He was discharged on a prolonged course of antibiotics and remained well at 1-year follow-up. Diagnosis is often missed initially because BP is not usually speciated on routine cultures. PET-CT helps diagnose disseminated melioidosis. Mortality is frequently caused by perioperative dissemination.