Background: Melioidosis-associated peri-prosthetic infection is extremely rare. To date, melioidosis associated septic arthritis of the ankle joint following a medial malleolar internal fixation has not been reported. Case presentation: We describe a 49-year-old male with a history of long standing diabetes who presented with fever, constitutional symptoms and right ankle pain for 1 week. Ten years ago, he underwent a medial malleolar screw fixation following a traumatic closed fracture. His initial right ankle radiographs showed no evidence of osteomyelitis. He underwent a wound debridement and washout of the right ankle joint. The peripheral blood and pus from the ankle joint was culture positive for Burkholderia pseudomallei with very high antibody titres. His subsequent radiographs showed features of chronic osteomyelitis. He was treated with a prolonged course of antibiotics and repeated wound debridement. At follow up after 6 months, he had no clinical features of recurrent infection. Conclusions: Melioidosis should be entertained in the differential diagnosis of peri-prosthetic infections in high risk patients.

Gall bladder perforation is a rare but serious complication of acute cholecystitis. Gall bladder perforations commonly occur in patients with comorbidities and in association with gall stones. We report a rare occurrence of intrahepatic type II perforation of the gall bladder in a previously healthy elderly male with acalculous cholecystitis. Lack of early positive findings related to clinical assessment, laboratory workup, and imaging resulted in a challenging diagnosis. High degree of clinical suspicion and close monitoring in such patients is necessary to detect early deterioration and improve outcomes.