An unusual case of sorethroat: nasopharyngeal melioidosis

A 14-year-old Chinese female presented with severe sorethroat and swinging fever for two weeks despite one course of oral amoxycillin followed by one course of Unasyn (combination of sultamicillin, sulbactam and ampicillin). Throat swab grew Pseudomonas pseudomallel. Serology for its antibodies was very strongly positive (> 1:512). In this part of the world the IHA titre of 1:16 or greater is significant. She was successfully treated with intravenous ceftazidime. The swinging fever settled within two days. The nasopharyngeal and oropharyngeal lesions cleared after a week of therapy. A further two weeks of Ceftazidime were given to ensure a complete resolution of the infection. Oral tetracycline was given for maintenance therapy. Melioidosis involving various organs have been reported particularly pulmonary melioidosis. Nasopharyngeal melioidosis has not been reported, as far as we know. This is the first reported case.