Published: 2018-05-25

An interesting case of back pain

Pratheeksha G. Rai, Chethan Subramanya


Meliodosis is a disease caused by gram negative bacterium Burkholderia pseudomallei. Among its various clinical presentations, involvement of spine is rare phenomenon. On presentation they mimic tuberculosis and malignancy. We present a case of an elderly male with known case of diabetes mellitus presented with fever of unknown origin associated with back pain. On evaluation, all tests for tuberculosis and malignancy remained negative. Multiple visceral abscesses with hyper intense foci in T4vertebrae were seen. Pleural fluid culture grew Burkholderia pseudomallei. Patient was treated with parenteral meropenem for 2 weeks, oral doxycycline and trimethoprim/sulphamethazone for 12 weeks. Dramatic decrease in back pain with improvement of constitutional symptoms was seen within 2 days of initiation of appropriate antibiotics. Meliodosis should be considered in differential diagnosis of back pain with constitutional symptoms. Dedicated team of microbiologists and physicians is required to identify and treat the disease.


Burkholderia pseudomallei, Meliodosis, Back pain, Visceral abscesses

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Kasper, Fauci, Hauser, Jameson, Loscalzo. Harrisons Principles of Internal Medicine 2015;19(2):1495-8.

Rahul Garg, Tushar Shaw, Shyamasunder N Bhat, Chiranjay Mukhopadhyay. BMJ case reports 2018: Feb 2018.

Janardanan P, Easaw PC, Rahiman A. an Unusual Case of Melioidosis with Psoas Abscess. Glob J Medical Clin Case Rep. 2017;4(1):15-7.

Gopalakrishnan R, Sureshkumar D, Thirunarayan MA, Ramasubramanian V. J Assoc Physicians India. 2013 Sep;61(9):612-4.

Princess I, Ebenezer R, Ramakrishnan N, Daniel AK, Nandini S, Thirunarayan M A. Melioidosis: An emerging infection with fatal outcomes. Indian J Crit Care Med. 2017;21:397-400.

Saravu K, Kadavigere R, Shastry AB, Pai R, Mukhopadhyay C. Neurologic melioidosis presented as encephalomyelitis and subdural collection in two male labourers in India. J Infection in Developing Countries. 2015 Nov 30;9(11):1289-93.

Navaneethan U, Ramesh kumar AC, Ravi G. Multiple visceral abscess in a case of Meliodosis, Indian J Med Sci. 2006;60:68-70.

Anshu Goel, Rahul Bansal, Shweta Sharma, Suman Singhal. Chronic meliodosis presenting with multiple abscesses. Oxford Medical Case Reports. 2016;6:113-6.