Two consecutive melioidosis septic arthritis successfully cured with conservative and operative treatment respectively: a case report

Abstract

Melioidosis or Whitmore’s disease is an uncommon infectious condition caused by the gram-negative bacterium Burkholderia pseudomallei. The clinical manifestation of melioidosis varies, including septicemia, pneumonia, deep organ and soft tissue abscess. Septic arthritis is a rare manifestation of melioidosis, which is associated with high mortality rate, especially in immunocompromised patients. We present here a 60-year-old male who was admitted to our hospital with high fever and acute left hip pain, who was subsequently confirmed to have hematogenous melioidosis septic arthritis with positive blood and synovial fluid cultures. His condition fully responded to a 2-week administration of intravenous meropenem plus oral trimethoprim+sulfamethoxazole, before he was transferred to his provincial hospital to continue the antibiotic regimen. For some reason, he inadvertently stopped the regimen and came back to us with a right elbow septic arthritis caused by the same microbial agent a month later. This time, he received an urgent elbow arthroscopic debridement and completed intensive antibiotic therapy before being discharged to continue the eradication phase for 6 months. Until now, he has recovered completely without recurrence. Melioidosis septic arthritis is rare but should be considered in high-risk patients and can be successfully treated with prompt antibiotics alone or in combination with surgery. Regardless of the method, eradication treatment is extremely important.