Disseminated melioidosis presenting as pre-septal cellulitis and multifocal abscesses in an adolescent with type 1 diabetes mellitus: a case report.

Abstract

Melioidosis, caused by Burkholderia pseudomallei, produces a wide range of clinical manifestations and may be difficult to diagnose in the pediatric population. We describe the case of a 12-year-old girl with poorly controlled type 1 diabetes mellitus that posed diagnostic challenges. Over 4 months, she experienced relapsing fever, multiple splenic abscesses with a 'target sign' on ultrasonography, right-sided preseptal cellulitis, and a left thigh ulcer. Repeated cultures of superficial swabs and blood yielded no growth of bacteria. Radiological mimicry and culture-negative results raised concerns regarding a fungal etiology, leading to empiric amphotericin B therapy. The definitive diagnosis was made after incision and drainage of a 4 × 6 cm2 frontal abscess. Pus culture isolated Burkholderia pseudomallei, identified by matrix‑assisted laser desorption/ionization time‑of‑flight mass spectrometry (MALDI‑ToF MS). Patient was treated with intravenous meropenem for 4 weeks followed by oral cotrimoxazole for a planned 3‑month eradication course. The patient recovered with no relapse on follow‑up. This case highlights the need to consider melioidosis in diabetic patients presenting with recurrent, culture-negative abscesses that display a target sign in endemic regions. Deep tissue culture remains essential for diagnosis, as superficial swabs may be misleading. Source control, coupled with dual-phase antimicrobial therapy, remain the cornerstones of effective management.