www.pneumonologia.viamedica.pl CASE REPORT 121 Address for correspondence: Dr. Baijayantimala Mishra, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, Pin-751019, e-mail: bm_mishra@hotmail.com DOI: 10.5603/PiAP.2016.0012 Received: 18.12.2016 Copyright © 2016 PTChP ISSN 0867–7077 Srujana Mohanty, Gourahari Pradhan, Manoj Kumar Panigrahi, Prasanta Raghab Mohapatra, Baijayantimala Mishra All India Institute of Medical Sciences, Bhubaneswar, Odisha, India A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations The authors declare no financial disclosure Abstract Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcuta- neous abscess, was undiagnosed for long, misidentifed as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identifcation of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics. Key words: melioidosis, Burkholderia pseudomallei, diabetes mellitus, systemic infection, pleural effusion Pneumonol Alergol Pol 2016; 84: 121–125 Introduction Melioidosis or “the remarkable imitator”, an acute infectious disease, caused by the environ- mental Gram-negative bacillus, Burkholderia pseudomallei , is endemic, widespread and an important public health problem in Southeast Asia and Northern Australia [1, 2]. It is being in- creasingly reported from other parts of the world, including India, China, Sri Lanka, and North and South America expanding the endemic zone of the disease [3, 4]. We report a case of melioidosis in a diabetic, occupationally unexposed male, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undia- gnosed for long, misidentifed as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identifcation of the etiologic agent and timely institution of appropriate therapy at our institute. Case A-58-year-old male, offce employee, was admitted to our hospital in mid-September 2015 with a history of unremittent high-grade fever with intermittent cough and expectoration for 3 months, a progressively increasing swelling on posterior left chest wall for two months, right-sided pleuritic chest pain for one month, and shortness of breath for 2 weeks. He had de- creased appetite and progressive loss of weight for the past one month. He was a known diabetic since 20 years managed with oral hypoglycaemic agents. There was no history of travel outside his place of residence in the preceding 6 months of his onset of symptoms. However, when probed,