Melioidosis presenting with periorbital cellulitis and rhinosinusitis

Melioidosis is an infectious disease caused by the bacteria Burkholderia pseudomallei. It has a variety of clinical manifestations ranging from localized abscess, to severe pneumonia to fatal septicaemia. Sinonasal and orbital manifestations of Melioidosis are rare [1] . This is the first reported case of Melioidosis presenting with orbital cellulitis and rhinosinusitis in Sri Lanka. A 42-year-old patient with diabetes mellitus presented with pyrexia of unknown origin, multiple abscesses in the leg, periorbital cellulitis and rhinosinusitis. Initial investigations did not reveal a diagnosis. Eventually it was diagnosed as Melioidosis with a positive blood culture and successfully managed with long term antibiotics. Early identification and aggressive management is needed to reduce the morbidity and mortality of Melioidosis. Awareness amongst clinicians of different specialties is important as this disease has variety of manifestations. He then underwent an urgent endoscopic sinus surgery, bilateral middle meatal antrostomy, etmoidectomy and sphenoidotomy. The mucosa of sinus cavities was normal. There was a necrotic mucosa in posterior nasal septum. The necrotic mucosa was removed and it was sent for urgent fungal studies and culture, histology and bacterial culture. There were no fungal filaments in the direct smear of this tissues. There were no bacteria or fungal growth in the cultures. Histology only revealed acute inflammatory changes and did not demonstrate any fungal filaments. Invasive fungal sinusitis was excluded.