Melioidosis: an unusual diagnosis for deep temporal and masticatory space infection following trauma

We report a patient in his early 70s, with an alleged history of trauma to the right temporal region, following which a swelling developed. A week later, erythematous changes, throbbing pain and occasional fever spikes were noted. A month after the initial trauma, he presented to our institution with necrosed skin over the right temporal region and swelling extending up to the vertex of the skull. The patient was an uncontrolled diabetic and had systemic conditions like chronic obstructive pulmonary disease and chronic kidney disease. A CT scan revealed a collection along the infratemporal space extending into the masticatory space. Routine investigations, blood culture sensitivity, were sent, which revealed the presence of Burkholderia pseudomallei sensitive to ceftazidime and imipenem. Under antibiotic coverage, the treatment was initiated, incision and drainage were done to reduce the bacterial load. However, the patient was lost to underlying systemic conditions and septic shock.