Uncommon Presentation of Cervical Abscess causing Melioidosis due to Burkholderia pseudomallei Infection in a Patient with Uncontrolled Diabetes Mellitus: A Case Report

Burkholderia pseudomallei is a saprophytic Gram-negative organism and facultative intracellular bacterium found in soil and water, and is responsible for causing melioidosis. It has the ability to imitate various diseases such as tuberculosis, pneumonia, and other pyogenic infections, which frequently result in misdiagnosis and improper treatment. In India, it has been previously misdiagnosed as tuberculosis and Pseudomonas infection, which may account for underreporting in the country. A 48-year-old female patient with type 2 diabetes mellitus and a past history of left breast carcinoma, operated on 2 years ago, presented with a history of high-grade fever with chills, along with a runny nose, dry cough, and generalised weakness for the last 4 days. She also complained of throat pain and noticed a swelling over the right side of her neck. Culture was suggestive of Burkholderia pseudomallei species, which was sensitive to cephalosporins and doxycycline, and she was immediately started on intravenous (IV) Zavicefta (IV ceftazidime) and oral doxycycline, along with antipyretics and supportive treatment. After 10 days, as she was haemodynamically stable, she was discharged with oral antibiotics for a further 2 weeks. Uncontrolled diabetes mellitus is a known predisposing factor for severe or atypical infections, which makes this case relevant to clinicians. This case highlights an unusual pathogen in a high-risk host, and its occurrence in deep neck infections is uncommon. This case was reported because it represents an uncommon presentation of Burkholderia infection in a patient with uncontrolled diabetes, which is commonly underreported in our country.