A 58-year-old man presented with severe right knee pain, swelling of the right leg, and breathlessness. Doctors at Wockhardt Hospitals, Mumbai Central, initially evaluated him for common conditions, including tuberculosis. However, further investigations revealed a rare tropical infection.
Clinical examination showed unilateral swelling in the right leg, intense knee pain, and low oxygen levels. Doppler studies confirmed deep vein thrombosis (DVT), while CT Pulmonary Angiography (CTPA) revealed pulmonary embolism (PE) — a potentially life-threatening condition in which blood clots travel to the lungs.
Emergency Treatment for Blood Clots
As per the press release, the medical team promptly initiated treatment. The patient underwent thrombolysis, followed by thrombosection and thrombus evacuation, which helped partially improve his oxygenation levels.
However, despite initial progress, his recovery soon became complicated by a persistent evening fever of 101°F, prompting doctors to reassess the situation.
Persistent Fever Raises Diagnostic Concerns
Since the fever continued, the team conducted further imaging studies. The results showed multiple concerning findings:
- High-Resolution CT (HRCT) Chest: Bilateral lung consolidation
- Magnetic Resonance Imaging (MRI) Knee: Features suggestive of septic arthritis
Because the patient had prolonged fever along with lung and joint involvement, doctors strongly suspected tuberculosis. Nevertheless, they proceeded with additional laboratory testing to confirm the diagnosis.
Blood Culture Reveals Melioidosis
Blood cultures eventually identified Burkholderia pseudomallei, confirming a diagnosis of melioidosis, an under-recognised but potentially serious infection seen in tropical regions.
Subsequently, doctors conducted a detailed exposure history. The patient recalled recently repairing old, soiled wooden furniture at home. During this work, he was likely exposed to contaminated dust.
Melioidosis is caused by bacteria commonly found in soil and stagnant water. Infection can occur through inhalation, ingestion, or direct contact with contaminated material. Importantly, the disease can also affect individuals without major immune compromise.
Diagnostic Challenges in Melioidosis
“Melioidosis can closely resemble tuberculosis or severe bacterial pneumonia, which makes early diagnosis challenging,” said Dr Honey Savla, Consultant Internal Medicine at Wockhardt Hospitals, Mumbai Central. “Therefore, when a persistent fever does not respond to standard treatment, clinicians should reconsider the diagnosis. Blood culture remains the gold standard for identifying this organism.”
Treatment and Recovery
Doctors performed surgical debridement of the infected knee joint and administered two weeks of intensive intravenous antibiotics. After the initial treatment phase, they transitioned the patient to prolonged oral eradication therapy, which is essential to prevent relapse in melioidosis.
Successful Outcome at Follow-Up
At the three-month follow-up, the patient showed significant improvement. He was pain-free, walking independently, and breathing normally. In addition, he continued anticoagulation therapy as part of his DVT management.
Importance of Clinical Vigilance
This case highlights the importance of maintaining clinical vigilance when patients present with persistent fever and multi-organ involvement. In tropical regions, clinicians should consider melioidosis as a differential diagnosis, especially when environmental exposure — even during routine household activities — could lead to infection.