Melioidosis presenting as erythema nodosum – a report of rare occurrence in literature

Background: Melioidosis caused by Burkholderia pseudomallei is an emerging illness in the Indian subcontinent. It has a wide range of clinical manifestations varying from more localized disease to systemic involvement causing overwhelming sepsis and death. Herein we report a case of an eleven-year-old girl presenting with fever, tonsillitis and erythema nodosum as the initial presentation of melioidosis.

Case presentation: An 11-year-old girl presented with high grade fever, sore throat with erythematous painful nodules over both lower limbs for few weeks duration. Where she was initially managed in a local hospital as erythema nodosum associated with streptococcal pharyngitis as antistreptolysin O_titre was elevated and treated with intravenous followed by oral penicillin without expected improvement. As a part of panniculitis work up in an endemic setting, melioidosis antibody level was performed which lead to the ultimate diagnosis.

Conclusion: Erythema nodosum is a rare manifestation of melioidosis. However high index of suspicion is needed in a high prevalent setting due to indistinctive and variable nature of clinical manifestations.