Melioidosis

A 52-year-old man, a paddy farmer from a coastal village in Udupi district, Karnataka, presents in August with 10 days of high-grade fever with rigors, a cough productive of purulent sputum, and a dull ache in the left upper abdomen. Over the last three days he has had burning micturition, frequency, and a heavy discomfort in the perineum. He has type 2 diabetes mellitus and takes his oral medication irregularly. He has worked barefoot in waterlogged fields throughout the monsoon.

A febrile illness in a diabetic rice farmer during the rainy season, with pneumonia, left upper quadrant pain, and new perineal symptoms suggesting spread to the spleen and prostate, points to a single diagnosis.