ELIOIDOSIS is an infectious disease M endemic to Southeast Asia. Through February 1967, 35 cases have been diagnosed in U.S.A. troops from Southeast Asia, with eight fata1ities.l Because of the large number of Americans returning from endemic areas, awareness of this disease by military and civilian physicians in this country is necessary. Occasionally, septic arthritis can be a major clinical manifestation of melioidosis.
CASE REPORT
J. B., a 30-year-old soldier, became acutely ill with spiking fever to 104 F. on July 16, 1966, 7 months after his arrival in South Vietnam. There were profuse sweating, chilly sensations, myalgia, anorexia, and progressive weight loss which eventually totaled 30 pounds. There had been no rash, adenopathy, diarrhea, jaundice, headache, urethral discharge, conjunctivitis, or history of tick bites. Physical examination was unremarkable. Hematocrit was 44 per cent, white blood count ranged from 8,800 to 11,400 with a normal differential count. Malaria smears, stool examination for ova and parasites, stool and blood cultures, and titers for scrub typhus were negative.
On July 27 a 10-day trial of oxytetracycline, 250 mg. every 6 hours, as treatment for scrub typhus was begun. A dry, nonproductive cough was noted. Chest x-ray was of poor quality and showed questionable infiltrates in the right middle lobe and left mid-lung field. The cough cleared spontaneously over the next 2 weeks, and subsequent chest x-rays were normal.
On the sixteenth hospital day an erythematous, hot, tender swelling developed over his first and second right metatarsal joints. There was no improvement following 3 mg. of colchicine given intravenously. Aspiration yielded a small amount of purulent fluid. Following incision of the metatarsal area, 5 ml. of similar fluid was removed.