title: An intriguing case of locked jaw secondary to melioidosis.
abstract: A 56-year-old woman presented with fever, pain and restriction of movement of the right temporomandibular joint. She was premorbidly diagnosed to have type 2 diabetes mellitus and rheumatoid arthritis. Local examination revealed a poorly demarcated severely tender, erythematous swelling in the right preauricular region. All haematological and biochemical investigations were within normal limits. MRI of the neck revealed the presence of a masticator space infection with intramuscular abscess involving the masseter and the temporalis muscles along with intracranial extension. Osteomyelitic changes were detected in the right mandibular condyle, temporal bone and in the temporomandibular joint. Melioidosis was suspected due to this unique clinical presentation of an abscess at an unusual and atypical site. Blood cultures identified the Gram-negative bacilli Burkholderia pseudomallei, which established the diagnosis of Melioidosis. Remarkable improvement was attained with antibiotics meropenem and cotrimoxazole, deferring the need for any surgical intervention.
authors.affiliation: Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India.
authors.forename: Tejasvini
authors.initials: T
authors.lastname: Vaid
authors.affiliation: Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Rao
authors.affiliation: Department of General Medicine, Kasturba Medical College, Manipal, Karnataka, India.
authors.forename: Handattu Manjunath
authors.initials: HM
authors.lastname: Hande
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008335:Mandibular Condyle / Q000382:microbiology / Q000473:pathology; D008406:Masseter Muscle / Q000382:microbiology / Q000473:pathology; D008554:Melioidosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D000077731:Meropenem; D008875:Middle Aged; D013701:Temporal Bone / Q000382:microbiology / Q000473:pathology; D013704:Temporomandibular Joint / Q000382:microbiology / Q000473:pathology; D013845:Thienamycins / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014313:Trismus / Q000382:microbiology* / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077731:Meropenem