Clival osteomyelitis as a rare complication of paediatric melioidosis

We report a rare case of melioidosis presenting with submandibular and parotid abscesses, complicated by clival osteomyelitis in a child. Diagnosis was confirmed by molecular testing of pus samples and a positive serology for Burkholderia pseudomallei despite negative blood cultures. The patient initially received intravenous ceftazidime and oral trimethoprim-sulfamethoxazole (TMP-SMX). However, she developed hypersensitivity reactions to TMP-SMX, requiring a switch to oral amoxicillin-clavulanate. She responded well with complete resolution of the submandibular and parotid abscesses after 4 weeks of treatment. This case emphasises the importance of a high index of suspicion of melioidosis in endemic regions due to its diverse clinical presentation and diagnostic challenges.