Palit Anik, Rahman Mahmudur, Rahman Md Mahfuzer, Akhtar Zubair, Rahman Mohammed Ziaur, Alam Muntasir, Deb Arpita Shyama, Chowdhury Sukanta, Rahman Md Mahfuzur, Das Pritimoy, Chowdhury Fahmida, Shuvo Tanzir Ahmed
Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
Global Health Development, EMPHNET, Dhaka, Bangladesh.
J Med Case Rep. 2025 Apr 9;19(1):168. doi: 10.1186/s13256-025-05190-6.
Melioidosis, which is caused by Burkholderia pseudomallei, is a disease with a high case fatality rate and a wide variety of disease manifestations causing diagnostic dilemmas for medical professionals. Risk factors such as diabetes contribute to a worse prognosis if not treated with appropriate antibiotics during the course of management. This case report describes a diabetic melioidosis case with a rare presentation of venous thrombosis of the lower limb and a successful course of treatment.
The patient was a 48-year-old Bangladeshi male who was admitted with gradually increasing left knee pain and intermittent high-grade fever for 7 days. On examination, he had a palpable spleen, high body temperature (102 °F), and pitting edema in the left lower limb during admission. He was treated with empiric meropenem on admission considering his serious illness. Doppler ultrasound of the left lower limb revealed superficial venous thrombosis and thrombophlebitis involving the long saphenous vein and superficial veins of saphenous territory below the knee. The patient was enrolled as an eligible case in a research study called the Acute Febrile Illness study. Blood culture confirmed the diagnosis as melioidosis. Doxycycline was added to his treatment regimen when the research study team informed the treating physician at the hospital about the diagnosis of melioidosis. He was discharged with cotrimoxazole, which was advised to be taken for 3 months.
This case report shows us the lack of diagnostics to detect melioidosis in hospital settings in Bangladesh. The successful treatment outcome proved the importance of routine surveillance for rare or unusual diseases, in addition to endemic pathogens. In addition, training is essential to improve knowledge and raise awareness among clinicians about the clinical diagnosis and management of melioidosis.
类鼻疽病由伯克霍尔德菌引起，是一种病死率高、疾病表现多样的疾病，给医学专业人员带来诊断难题。糖尿病等危险因素若在治疗过程中未使用适当抗生素，会导致预后更差。本病例报告描述了一例糖尿病类鼻疽病患者，其罕见地出现下肢静脉血栓形成，并成功治愈。
患者为一名48岁的孟加拉男性，因左膝疼痛逐渐加重和间歇性高热7天入院。入院检查时，可触及脾脏，体温较高（102°F），左下肢有凹陷性水肿。考虑到病情严重，入院时给予经验性美罗培南治疗。左下肢多普勒超声显示浅静脉血栓形成及血栓性静脉炎，累及大隐静脉及膝以下大隐静脉区域的浅静脉。该患者被纳入一项名为急性发热疾病研究的研究项目作为合格病例。血培养确诊为类鼻疽病。当研究团队告知医院的主治医生患者患有类鼻疽病时，治疗方案中加用了多西环素。患者出院时带复方新诺明，建议服用3个月。
本病例报告向我们展示了孟加拉国医院环境中缺乏检测类鼻疽病的诊断方法。成功的治疗结果证明了除地方性病原体外，对罕见或不寻常疾病进行常规监测的重要性。此外，培训对于提高临床医生对类鼻疽病的临床诊断和管理的知识水平和认识至关重要。
