Melioidosis presenting as knee joint septic arthritis: a case report

Abstract

A 56-year-old woman having type 2 diabetes, presented with intermittent high-grade fever for three weeks and right knee joint pain and swelling with restricted movements. She has had a prick injury to the left sole two weeks ago in the paddy field. Investigations revealed neutrophil leucocytosis and raised inflammatory markers. Blood culture was sterile. Joint fluid was turbid with neutrophil predominance, but the culture was sterile. Chest x-ray showed bilateral multiple patchy consolidations, that turned out to be abscesses on contrast-enhanced CT scan. The history of prick injury, diabetes, and the presence of multiple lung abscesses made us ponder a diagnosis of melioidosis. Although cultures were negative, melioidosis antibody titer was raised. She was treated with ceftazidime and doxycycline for one month, followed by co-cotrimoxazole and doxycycline for three months. She was completely cured after the course of antibiotics.