A case of recurrent and seronegative melioidosis with deep seated abscesses

Melioidosis has a varied clinical presentation. This is a case of recurrent melioidosis with deep seated abscesses in a 46-year-old male who presented with a prolonged fever. He had  intermittent fever since 2020 which was eventually diagnosed as melioidosis in 2021 following isolation of Burkholderia pseudomallei from a blood culture. Following treatment, he was asymptomatic. However, seven months later the fever recurred and needed reinvestigation. Inflammatory markers were high and contrast CT scan showed multiple abscesses in lungs, liver and spleen. Three blood cultures and melioidosis antibodies were negative. As other causes were excluded he was treated as recurrence of melioidosis with IV antibiotics for 28 days and followed by oral antibiotics for four months and remains well to date. The diagnosis of melioidosis can be challenging and high level of clinical suspicion is warranted. Following diagnosis, treatment with appropriate antibiotics for an adequate duration is vital to ensure complete cure and minimize chances of a recurrence