Melioidosis in a patient with type 1 diabetes mellitus on an insulin pump

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. LEARNING POINTS: 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.