Burkholderia pseudomallei Osteomyelitis of the Metatarsal in an Infant

Burkoholderia pseudomallei is an emerging cause of localized musculoskeletal infections. We report the case of a 9-month-old infant with isolated primary chronic osteomyelitis of the fifth metatarsal. Radiographs showed expansion and thickening of the cortex. The metatarsal had lytic lesions with scalloped margins; no periosteal reaction or sequestration was seen. Surgical debridement provided removal of infected material and adequate drainage by saucerization. B. pseudomallei was isolated from purulent material, and histologic examination revealed granulomatous inflammation. The child responded rapidly to a 2-week intravenous course of ceftazidime. The present case highlights the need for an awareness of melioidosis as a new differential diagnosis for a nontuberculous, granulomatous inflammation in those living in or visiting tropical regions.