The Great Mimicker in Bone: A Rare Case of Melioidosis With Multifocal Skeletal Manifestations and Diagnostic Challenges

Melioidosis, caused by the Gram-negative bacillus Burkholderia pseudomallei (B. pseudomallei), is an emerging infectious disease endemic to Southeast Asia and northern Australia, well known for its protean manifestations and aptly termed “the great mimicker.” Skeletal involvement, although an established entity, remains underreported, particularly when affecting multiple bones simultaneously in the setting of newly diagnosed diabetes mellitus. We report a 35-year-old male patient with newly diagnosed type II diabetes mellitus who presented with fever and right knee pain. Surgical debridement of a right distal thigh abscess with bone biopsy yielded B. pseudomallei on culture. Subsequent imaging revealed multifocal skeletal disease involving the right distal femur, bilateral knees, left heel (calcaneum, talus, distal tibia), and cervical vertebrae (C2-C6), accompanied by pulmonary septic emboli. The patient required two surgical interventions - right thigh debridement and left knee arthrotomy - and was managed with intravenous meropenem during the intensive phase, with intravenous co-trimoxazole added as an adjunct, resulting in gradual clinical improvement. This case highlights the diagnostic complexity of skeletal melioidosis in a diabetic patient presenting simultaneously with multifocal osteomyelitis, septic arthritis, pulmonary involvement, and possible spinal disease. A high index of clinical suspicion, early microbiological culture, and prompt targeted antibiotic therapy are essential to prevent mortality and morbidity in such cases.