Case Report: Melioidosis-Related Severe Cutaneous Features of Erythema Nodosum in a Thai Child

Nattakarn Tantawarak Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

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Leelawadee Techasatian Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

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Piti Ungarreevittaya Pathology Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

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Pope Kosalaraksa Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

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Pagakrong Lumbiganon Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;

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ABSTRACT.

Erythema nodosum (EN) is characterized by rapidly developing, painful, erythematous subcutaneous nodules, most of which are located in the pretibial areas. This cutaneous finding can be caused by a variety of conditions, however Burkholderia pseudomallei is rarely the cause. This particular patient presented with a high-grade fever with characteristic EN on both pretibial areas. All of the typical EN causes were investigated, but the findings were all negative. The lesions progressed to severe hemorrhagic bleb features, and because the patient resided in Northeast Thailand, a melioidosis-endemic region, testing for B. pseudomallei was performed. Because a high level of melioidosis serology of more than 1:10,240 was detected, melioidosis therapy was started. At the 12-week follow-up after melioidosis therapy, the titer had declined to 1:1,280, indicating that melioidosis-related severe, cutaneous EN symptoms were the most likely diagnosis in this patient. We discovered a case of EN with severe hemorrhagic bleb features as a unique clinical manifestation of melioidosis. When a patient resides in an endemic area, B. pseudomallei should always be considered as a possible causative organism.

Author Notes

Disclosure: This study was approved by the Institutional Review Board of Khon Kaen University, Human Research Ethics Committee (#HE651581). The parents gave written consent.

Authors’ addresses: Nattakarn Tantawarak, Leelawadee Techasatian, Pope Kosalaraksa, and Pagakrong Lumbiganon, Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mails: natttan@kku.ac.th, leelawadee@kku.ac.th, kosalaraksa@yahoo.com, and paglum@kku.ac.th. Piti Ungarreevittaya, Pathology Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mail: pitiun@kku.ac.th.

Address correspondence to Leelawadee Techasatian, Dermatology Unit, Pediatric Division, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 40002. E-mail: leelawadee@kku.ac.th
  • 1.

    Panamonta O , Lumbiganon P , 1997. Diabetic ketoacidosis and melioidosis in a child. J Med Assoc Thai 80: 671674.

  • 2.

    Fertitta L , Monsel G , Torresi J , Caumes E , 2019. Cutaneous melioidosis: a review of the literature. Int J Dermatol 58: 221227.

  • 3.

    Lumbiganon P , Kosalaraksa P , 2013. Uncommon clinical presentations of melioidosis in children: 2 cases with sore throat and 1 case with urticarial rash. Southeast Asian J Trop Med Public Health 44: 862865.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Lumbiganon P , Viengnondha S , 1995. Clinical manifestations of melioidosis in children. Pediatr Infect Dis J 14: 136140.

  • 5.

    Lumbiganon P , Chotechuangnirun N , Kosalaraksa P , Teeratakulpisarn J , 2011. Localized melioidosis in children in Thailand: treatment and long-term outcome. J Trop Pediatr 57: 185191.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Diolombi M , Seneviratne M , Norton R , 2020. Case report: erythema nodosum and melioidosis: an unreported association. Am J Trop Med Hyg 103: 18411843.

  • 7.

    Tan PY , Goh JY , 2022. Erythema nodosum: an atypical presentation of melioidosis. Rev Soc Bras Med Trop 55: e00362022.

  • 8.

    Leung AKC , Leong KF , Lam JM , 2018. Erythema nodosum. World J Pediatr 14: 548554.

  • 9.

    Limmathurotsakul D , Wuthiekanum V , Wongsuvan G , Pangmee S , Amornchai P , Teparrakkul P , Teerawattanasook N , Day NPJ , Peacock SJ , 2011. Repeat blood culture positive for B. pseudomallei indicates an increased risk of death from melioidosis. Am J Trop Med Hyg 84: 858861.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Stavrou C , Veraitch O , Morris-Jones S , Walker SL , 2021. Leg ulceration due to cutaneous melioidosis in a returning traveller. BMJ Case Rep 14: e241490.

  • 11.

    Charoenwong P , Lumbiganon P , Puapermpoonsiri S , 1992. The prevalence of the indirect hemagglutination test for melioidosis in children in an endemic area. Southeast Asian J Trop Med Public Health 23: 698701.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Karunanayake P , 2022. Melioidosis: clinical aspects. Clin Med (Lond) 22: 68.

  • 13.

    Levi M , Scully M , Singer M , 2018. The role of ADAMTS‐13 in the coagulopathy of sepsis. J Thromb Haemost 16: 646651.

  • 14.

    Panuncialman J , Falanga V , 2010. Unusual causes of cutaneous ulceration. Surg Clin North Am 90: 11611180.

  • 15.

    Sullivan RP , Marshall CS , Anstey NM , Ward L , Currie BJ , 2020. 2020 Review and revision of the 2015 Darwin melioidosis treatment guideline: paradigm drift not shift. PLoS Negl Trop Dis 14: e0008659.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Anunnatsiri S et al., 2021. A comparison between 12 versus 20 weeks of trimethoprim-sulfamethoxazole as oral eradication treatment for melioidosis: an open-label, pragmatic, multicenter, non-inferiority, randomized controlled trial. Clin Infect Dis 73: e3627e3633.

    • PubMed
    • Search Google Scholar
    • Export Citation
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