Chronic melioidosis causing an inguinal sinus in a Sri Lankan male

Melioidosis is an emerging infection in South Asia. It has a spectrum of presentation causing many difficulties in early diagnosis and the control of infection. Here we report a rare case of melioidosis causing an inguinal sinus in a Sri Lankan male.

This 54‐year‐old male had recurrent admissions to hospital with multiple acute infections including acute inguinal lymphadenitis, left lobar pneumonia and septic arthritis of the left knee joint. He was treated with short courses of antibiotics. Blood cultures revealed no bacterial growth. Ultrasound scan of the abdomen showed multiple loculated abscess formation typical of melioidosis. Repeat blood culture in selective Ashdown's medium was positive for the growth of Burkholderia pseudomallei. He was treated with ceftazidime and imipenem for 4 weeks but was lost to follow‐up before starting an eradication regimen. Later, he presented with a large left inguinal sinus and a draining sinus in the left thigh.

Presence of multiple septic foci in this patient within a short span of time was due to discharge of bacilli into the bloodstream from the hidden infection in the spleen. This is a good example of an immune organ itself acting as a source of infection under suboptimal immune response. This case also highlights the importance of full screening and complete eradication of the infection at the initial diagnosis before establishment in relatively avascular tissues.