Successful Treatment of Localized Cutaneous Melioidosis with Oral Antibiotic Therapy Alone

A 65-year-old man, who was usually well, presented to the outpatients' department of Cairns Hospital, in tropical Australia with a 3-week history of an evolving, but non-painful, purulent lesion on his right shin. He was afebrile and had no other symptoms. He enjoyed gardening and recalled sustaining multiple superficial skin lacerations and being exposed to flood water approximately 8 weeks previously. His physical examination was completely unremarkable, apart from a single raised, erythematous, indurated, crusted, 2 · 2-cm lesion on his right shin (Figure 1 A). A superficial swab of the lesion isolated Burkholderia pseudomallei. establishing the diagnosis of melioidosis. Two sets of blood cultures were negative, and a chest X-ray and computerized tomography scan of the abdomen and pelvis were normal, it was recommended that the patient receive outpatient intravenous ceftazidime through a peripherally inserted central venous catheter; however, he was concerned about the potential for catheter-associated complications, and elected to receive only oral therapy. He was therefore treated with a 3-month course of trimethoprim/sulfamethoxazole (TMP/SMX), 320/1,600 mg twice daily, with daily folic acid and close outpatient monitoring. He noticed significant improvement after only 2 days of therapy, and the lesion had resolved completely by the end of treatment (Figure 1B). Two months later, there has been no evidence of recurrence.