A case of recurrent and seronegative melioidosis with deep seated abscesses

Melioidosis has a varied clinical presentation. This is a case of recurrent melioidosis diagnosed in a 46 year old male with a prolonged febrile illness and multiple deep seated abscesses. He had intermittent fever since 2020 which was eventually diagnosed as melioidosis in 2021 following isolation of Burkholderia pseudomallei from a blood culture. Treatment was given and he was asymptomatic for seven months, but the fever recurred and needed reinvestigation. Inflammatory markers were high and contrast CT scan revealed multiple abscesses in the liver, spleen and lungs. Bacterial culture in blood and melioidosis antibodies were negative. As other causes were excluded, he was treated as recurrence of melioidosis with a prolonged course of antibiotics and remains well to date. The diagnosis of melioidosis is challenging and clinicians should be aware of the varied presentations. Following diagnosis, treatment with appropriate antibiotics for an adequate duration is vital to ensure complete cure and minimize chances of a recurrence.