{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:35:24Z","timestamp":1788989724195,"version":"build-2803163510"},"reference-count":12,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Melioidosis is a potentially fatal infection caused by <jats:italic>Burkholderia pseudomallei<\/jats:italic> that is often underdiagnosed because of its diverse clinical presentations. We report the case of a 49-year-old female farmer from Tamil Nadu who presented with a 10-day history of fever, productive cough, and breathlessness followed by a rapidly progressive ulceronecrotic lesion on the forehead for 6 days. Examination revealed a 3 \u00d7 2 cm crusted eschar with surrounding edema. Blood, pus swab, and tissue bit grew <jats:italic>B. pseudomallei<\/jats:italic>, and imaging showed multiple abscesses in the lungs, liver, spleen, and brain. She was newly diagnosed with diabetes (hemoglobin A1c: 9.2%) and treated with intravenous meropenem, but she succumbed to refractory septic shock. This case highlights the need to recognize atypical cutaneous signs as early indicators of disseminated melioidosis, especially in endemic regions, and the importance of timely, appropriate antibiotic therapy.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0320","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T15:02:26Z","timestamp":1755010946000},"page":"734-736","source":"Crossref","is-referenced-by-count":1,"title":["Ulceronecrotic Eschar as a Cutaneous Clue to Disseminated Melioidosis"],"prefix":"10.4269","volume":"113","author":[{"given":"Venkateswaran","family":"Ramanathan","sequence":"first","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepti","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Premalatha Jaganathan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit M.","family":"Kamat","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monisha","family":"Gopal Aswath","sequence":"additional","affiliation":[{"name":"Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Kumari","sequence":"additional","affiliation":[{"name":"Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Pathogens","first-page":"379","article-title":"Two decades of melioidosis in India: A comprehensive epidemiological review","volume":"14","author":"Kannan","year":"2025"},{"key":"b2","series-title":"Int J Infect Dis","first-page":"e491","article-title":"Emerging clinicoepidemiological trends in melioidosis: Analysis of 95 cases from western coastal India","volume":"16","author":"Vidyalakshmi","year":"2012"},{"key":"b3","series-title":"J Clin Diagn Res","first-page":"WD01","article-title":"Cutaneous melioidosis","volume":"10","author":"Achappa","year":"2016"},{"key":"b4","series-title":"Lancet Infect Dis","first-page":"e176","article-title":"A call to action: Time to recognise melioidosis as a neglected tropical disease","volume":"22","author":"Savelkoel","year":"2022"},{"key":"b5","series-title":"J Assoc Physicians India","first-page":"612","article-title":"Melioidosis: An emerging infection in India","volume":"61","author":"Gopalakrishnan","year":"2013"},{"key":"b6","series-title":"Curr Res Microb Sci","first-page":"100346","article-title":"The spatial mapping of melioidosis exposure in the eastern Indian state of Odisha","volume":"8","author":"Sarin","year":"2025"},{"key":"b7","series-title":"J Am Acad Dermatol","first-page":"1201","article-title":"Cutaneous melioidosis: An updated review and primer for the dermatologist","volume":"89","author":"Schwartzman","year":"2023"},{"key":"b8","series-title":"Clin Infect Dis","first-page":"603","article-title":"Cutaneous melioidosis in the tropical top end of Australia: A prospective study and review of the literature","volume":"47","author":"Gibney","year":"2008"},{"key":"b9","series-title":"PLoS Negl Trop Dis","first-page":"e0004610","article-title":"Seroprevalence of Burkholderia pseudomallei among adults in coastal areas in southwestern India","volume":"10","author":"Vandana","year":"2016"},{"key":"b10","series-title":"Acta Med Indones","first-page":"555","article-title":"Cutaneous anthrax: What is the hallmark?","volume":"56","author":"Harioputro","year":"2024"},{"key":"b11","series-title":"J Ayub Med Coll Abbottabad","first-page":"439","article-title":"Ecthyma gangrenosum: Case report of 5-month-old female","volume":"36","author":"Anwar","year":"2024"},{"key":"b12","series-title":"Oral Surg Oral Med Oral Pathol Oral Radiol","first-page":"708","article-title":"Rhinocerebral mucormycosis: A systematic review of case reports and case series from a global perspective","volume":"134","author":"Kumar","year":"2022"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p734.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p734.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p734.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:29:55Z","timestamp":1759339795000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p734.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":12,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0320","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}