Burkholderia pseudomallei-induced Oligoarticular Septic Arthritis Masquerading as Tuberculosis in a Non-Diabetic Host from Northern Kerala.

Introduction: Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in tropical and subtropical regions, primarily in Southeast Asia and northern Australia. Cases of septic arthritis caused by B. pseudomallei in India have rarely been reported and have been described mostly in diabetic patients. This case report outlines a case of oligoarticular septic arthritis in a non-diabetic patient with a previous history of extrapulmonary tuberculosis (TB).

Case report: A 62-year-old non-diabetic male receiving anti-tubercular therapy (ATT) for tubercular lymphadenitis presented with complaints of painful swelling of his left knee and right shoulder. Before consulting with us, he had undergone an arthrotomy and biopsy of his left knee at a different center. The biopsy was suggestive of granulomatous inflammation with negative cultures and acid-fast bacillus, for which he was advised to continue ATT for an extended duration. ATT did not improve his symptoms, and the patient developed a gradually progressing painful swelling of his right shoulder. At this point, he presented to us. Fresh cultures revealed B. pseudomallei as the causative organism. A strict regimen of intravenous ceftazidime followed by oral cotrimoxazole resulted in gradual recovery.

Conclusion: Cases of B. pseudomallei-induced infective arthritis and systemic melioidosis are now being identified in India, probably as a result of increased cross-country travel. This case report describes oligoarticular septic arthritis in a non-diabetic patient, which is unique among similar cases in the literature. A previous history of TB and negative routine cultures confounded the diagnosis.