Melioidotic Osteomyelitis of the Femur Occurring in a Traveler

Burkholderia pseudomallei is a gram-negative bacillus mainly distributed in South Asia, northern Australia and Iran. 1 However, its incidence is probably greatly underestimated in other regions of the tropical world due to the lack of diagnostic microbiology facilities. Multiple clinical presentations of B. pseudomallei have been reported ranging from localized,benign infection to fulminant septicemia. 2 Relapse of the infection is frequent even among those completing a full course of antibiotic treatment. Septic arthritis and osteomyelitis are an uncommon presentation of the disease; 14 cases have been reported during the last 10 years. 3,4 The optimal treatment remains elusive. We describe a case of melioidotic osteomyelitis treated with an imipenem and doxycycline regimen. A 46-year-old Englishman, who had a 3-week history of traveling in Thailand and jungle tracking at Perhentian Island, Malaysia, presented with a 10-day history of fever, chills, rigors, and right thigh pain and was admitted to Kuala Terengganu Hospital in Malaysia. On examination, he was febrile with temperature of 39.6°C. The right thigh was painful with some limitation of range of movement. A full blood count demonstrated a white cell count of 11.7 10 9 /L with predominant neutrophilia and an erythrocyte sedimentation rate (ESR) of 106 mm/h. Blood cultures grew B. pseudomallei and he was started with intravenous ceftazidime and amoxicillinclavulanate. Seven days later he was repatriated to France, where he used to live, and therefore was admitted to our