Melioidosis, caused by Burkholderia pseudomallei, is an important endemic infection in Southeast Asia. Pulmonary infection and bacteremia are most common presentations whereas musculoskeletal involvement is less frequent and infection associated with orthopedic implants is rarely reported. We describe a case of a 47-year-old man who was presented with swelling in the back following a complicated recovery from a prior unstable chance fracture of T12 and L1 vertebrae which he acquired during an industrial injury at his workplace. He underwent a Posterior Sacro-iliac Spine Fusion for the vertebral function. He also sustained multiple medical and psychiatric conditions including paraplegia, neurogenic bladder and Major Depressive Disorder (MDD) following the spinal injury. After discharged, he had experienced recurrent episodes of infections related to spinal implant. On this current presentation, his pus culture grew Burkholderia pseudomallei, which was a rare pathogen that could be associated with implant infections. Patient had also developed hyperkalemia which was one of the adverse effect from trimethoprim-sulfamethoxazole which was one of the antimicrobial therapy used for Burkholderia pseudomallei. This case illustrates the challenges in handling a rare infection associated with spinal implant and in managing adverse effect of hyperkalemia associated with Trimethoprim-sulfamethoxazole.