Osteomyelitis caused by Burkholderia pseudomallei: relapse six years after pulmonary infection

Burkholderia pseudomallei is highly endemic in Southeast Asia, whereas in Europe usually only few imported cases of melioidosis occur.

In 2006, a 52-year-old male patient had been admitted to hospital with pneumonia after returning from a trip to Thailand. A blood culture isolate had been identified as Pseudomonas fluorescens and the patient had been treated with Piperacillin according to the antibiogram. Six years later the patient developed osteomyelitis of the leg and Burkholderia pseudomallei was identified as the causative agent.

Misidentification of the cultural isolate in 2006 had led to inadequate therapy and to an unusually late relapse of melioidosis six years later.