Multifocal Bone and Visceral Melioidosis in a Cirrhotic Patient Identified by 99mTc MDP Bone Scan

A 58-year-old diabetic male with hepatic cirrhosis presented with fever and vague bone pains. Technetium methylene diphosphonate (Tc MDP) three phase bone scan (Figures 1 and 2) identified not only multiple sites of bone involvement but also extraskeletal renal involvement that was later proven by culture. Burkholderia pseudomallei was isolated from a blood culture, confirming a diagnosis of systemic melioidosis. Although lung abscess is the most common presentation disseminated disease often occurs, particularly in the presence of impaired host immunity, which was apparent in this patient. Pleural effusion, skin and soft tissue swellings, and liver and splenic abscesses may be encountered. Neurological involvement (brain stem encephalitis, cerebral abscess, cranial nerve