Musculoskeletal melioidosis masquerading as diabetic amyotrophy

AWC Kow, KBL Lee, YS Wong
Correspondence: Dr Alfred Kow Wei Chieh, Alfredkow@hotmail.com

ABSTRACT
A patient with musculoskeletal melioidosis masquerading as diabetic amyotrophy is described. A 43-year-old man presented with left thigh pain, fever, malaise and loss of weight. He had diabetes mellitus for six years. He was initially diagnosed with diabetic amyotrophy and was treated conservatively. Recurrence of symptoms prompted further investigations which revealed melioidosis of the left femur. Magnetic resonance imaging showed an enhancing subperiosteal collection. The diagnosis was confirmed by open biopsy and tissue culture. Acute treatment consisted of intravenous ceftazidime for 24 days and oral cotrimoxazole. The patient showed marked improvement clinically and biochemically. He was discharged with oral doxycycline and cotrimoxazole for three months. This disease is eminently treatable, but can be a diagnostic challenge when it presents in an uncommon site.

Keywords: Diabetes amyotrophy, diabetes mellitus, melioidosis, musculoskeletal infection
Singapore Med J 2005; 46(5): 233-235