Primary skin melioidosis in a returning traveler

Excerpt

A 28-year-old previously healthy female Thai native German resident reported a history of headache and fever with a singular wound for 5 weeks on the lower back after vacation in Bangkok/Thailand. The lesion was elevated with a cauliflower-like aspect (Fig. 1a). The patient reported local tenderness and denied night sweats or weight loss. The physical examination was otherwise unrevealing. Wound-swab cultures were obtained and empirical treatment started with ciprofloxacin 500 mg BID. Blood tests (CBC, CRP, ESR, basic liver- and retention parameters) were within normal limits. Serologically, no evidence for syphilis, Leishmania spp. or HIV. Swab cultures grew whitish wrinkled colonies on blood media which were identified with MALDI-TOF–MS¹ [1] to be Burkholderia pseudomallei. AST² demonstrated susceptibility against tetracycline, piperacillin and quinolones as well as ceftazidime. Resistance against cotrimoxazole, a possible treatment option was detected. Although the wound showed healing tendencies (Fig. 1b) after 7 days of ciprofloxacin treatment, regimen was changed to ceftazidime i.v. 40 mg/kg for 10 days and a follow up of 56 days of doxycycline 100mg BID. The skin closed completely and left a hyperpigmented scar (Fig. 1c). Immuno-Blot against B. pseudomallei LPS-Type-A was positive [2].

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