Unsuspected deep venous thrombosis and pulmonary embolism in melioidosis

Melioidosis is caused by the gram-negative, intracellular bacterium Burkholderia pseudomallei which can be life-threatening. This organism is found in soil and surface water in tropical and subtropical regions including Southeast Asia and northern Australia. While it usually presents as pneumonia or septicaemia in immunocompromised individuals, its manifestation as deep venous thrombosis (DVT) and pulmonary embolism (PE) remains underrecognised. We report a case of a 43-year-old man with poorly controlled diabetes mellitus who presented with fever, cough and progressive dyspnoea. Blood cultures confirmed Burkholderia pseudomallei. Further imaging revealed pulmonary embolism and extensive iliac vein thrombosis, which had not been clinically suspected. This case draws attention to an uncommon, yet serious complication of melioidosis, and it highlights the importance of maintaining a high index of suspicion for thrombotic events in patients with melioidosis, particularly those with underlying diabetes. Early recognition and prompt treatment of both infection and thrombosis are vital to improve patient outcomes.