Burkholderia pseudomallei – The malicious invader causing orbital cellulitis !!!

Abstract

This case report represents an unusual presentation of Melioidosis presenting as orbital cellulitis. Orbital cellulitis is an acute infection of the eye, commonly caused by Staphylococcal, Streptococcal species and also by fungi. Here we report a case of a 57 year old male who was a diabetic and hypertensive presented with fever, protrusion of right eyeball with sudden onset of defective vision. On examination right eye visual acuity was light perception with relative afferent pupillary defect. Proptosis, chemosis and total ophthalmoplegia were present. Routine investigation revealed leucocytosis. Conjunctival swab culture was negative whereas blood culture revealed Burkholderia pseudomallei. On further work up ultrasound abdomen showed splenic abscess. Even with effective treatment with IV antibiotics patient didn’t improve and succumbed to this disease. Ocular involvement in melioidosis is rare but can lead to devastating outcomes. This case represents the highly virulent nature of this organism which rarely presents with ocular involvement as primary presentation.