BMJ Case Reports 2018; doi:10.1136/bcr-2017-223223
  • Rare disease

Melioidosis: the great mimicker presenting as spondylodiscitis

  1. Chiranjay Mukhopadhyay
  1. Kasturba Medical College Manipal, Manipal University, Manipal, India
  1. Correspondence to Dr Chiranjay Mukhopadhyay, chiranjay{at}
  • Accepted 25 January 2018
  • Published 8 February 2018


Melioidosis, a syndrome with protean clinical manifestations, is caused by Gram-negative soil saprophyte Burkholderiapseudomallei. Among its diverse clinical presentations, the involvement of spine is a rare phenomenon and can mimic tuberculosis on presentation. A 65-year-old female with a known case of diabetes presented with fever with lower back pain. Blood culture grew Staphylococcus aureus, and as per sensitivity report, clindamycin and cefazolin were started. X-ray and MRI lumbosacral spine showed spondylodiscitis (likely Koch’s). Decompression and biopsy were done, and a sample was sent for microbiological investigations that showed no growth of any significant pathogen; furthermore, all tests for tuberculosis diagnosis also remained negative. Active Melioidosis Detect Lateral Flow Assay was used on the tissue sample, which was positive for B. pseudomallei Capsular Polysaccharide (CPS) antigen; the case was confirmed by typethree secretion system 1 PCR for melioidosis. Antibiotics were changed to parenteral ceftazidime for 2 weeks followed by oral cotrimoxazole. A dedicated team of microbiologists and physicians is required to identify and treat the disease.


  • Contributors RG: collected details of the patient and followed up and drafted the manuscript. TS: acquisition of data and edited the manuscript. SNB: involved in active treatment of case and assisting surgery. CM: planned the concept and study, final editing and submission of manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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