Diabetes mellitus is a well-recognised risk factor for melioidosis, the disease caused by Burkholderia pseudomallei, which is endemic in northern Australia and Southeast Asia. We present the initial diagnostic dilemma of a febrile patient from northern Australia with type 1 diabetes mellitus and negative blood cultures. After a 6-week history of fevers and undifferentiated abdominal pain, MRI of her spine revealed a psoas abscess. She underwent drainage of the abscess which cultured B. pseudomallei. She completed 6 weeks of intravenous (IV) ceftazidime and oral trimethoprim/sulphamethoxazole (TMP/SMX) followed by a 12-week course of oral TMP/SMX. We postulate that the likely route of infection was inoculation via her skin, the integrity of which was compromised from her insulin pump insertion sites and an underlying dermatological condition.
- Diabetes mellitus is the strongest risk factor for developing melioidosis.
- Atypical infections need to be considered in individuals with diabetes mellitus who are febrile, even if blood cultures are negative.
- There is heterogeneity in the clinical presentation of melioidosis due to variable organ involvement.
- Consider melioidosis in febrile patients who have travelled to northern Australia, Asia and other endemic areas.