Mumbai, March 2026:
A 58-year-old man who developed severe knee pain, right leg swelling and breathlessness was diagnosed with a rare tropical infection after initially being evaluated for more common conditions such as tuberculosis. The case was managed at Wockhardt Hospitals, Mumbai Central.

He first presented with unilateral right leg swelling, intense right knee pain and low oxygen levels. Investigations confirmed deep vein thrombosis (DVT) on Doppler studies, while CT Pulmonary Angiography (CTPA) revealed pulmonary embolism (PE) — a potentially life-threatening complication where blood clots travel to the lungs. He underwent thrombolysis followed by thrombosection and thrombus evacuation, which led to partial improvement in oxygenation.

However, his recovery was complicated by a persistent evening fever of 101°F. The continuing fever prompted further evaluation.

Subsequent imaging showed:
• High-Resolution CT (HRCT) chest: Bilateral lung consolidation
• Magnetic Resonance Imaging (MRI) knee: Findings suggestive of septic arthritis

Given the prolonged fever, lung involvement and joint infection, tuberculosis was strongly suspected. However, blood cultures identified Burkholderia pseudomallei, confirming a diagnosis of melioidosis — an under-recognised but potentially serious infection seen in tropical regions.

On detailed questioning, the patient recalled recently repairing old, soiled wooden furniture at home, during which he was likely exposed to contaminated dust. Melioidosis is caused by bacteria found in soil and stagnant water, and infection can occur through inhalation or direct contact. Even individuals without major immune compromise can be affected.

“Melioidosis can closely resemble tuberculosis or severe bacterial pneumonia, which makes early diagnosis challenging,” said Dr Honey Savla, Consultant Internal Medicine at Wockhardt Hospitals, Mumbai Central. “A persistent fever that does not respond as expected should prompt clinicians to reassess the diagnosis. Blood culture remains the gold standard for identifying this organism.”*

The patient underwent surgical knee joint debridement, followed by two weeks of intensive intravenous antibiotics. He was then transitioned to prolonged oral eradication therapy to prevent relapse — a critical step in managing melioidosis.

At three-month follow-up, he was pain-free, walking independently, breathing normally and continuing anticoagulation therapy for DVT management.

The case highlights the importance of maintaining clinical vigilance and considering melioidosis in patients with persistent fever and multi-organ involvement, particularly in tropical regions where environmental exposure — even during routine household work — can sometimes lead to significant infection.