Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report

Journal of Medical Case Reports

Vishwanath Sathyanarayanan¹  Sushma Krishna²  Kundapura Ramamoorthy¹  Barkur Ananthakrishna Shastry¹  Vandana Kalwaje Eshwara³  Chiranjay Mukhopadhyay³  Kavitha Saravu¹ 

[1] Department of Internal Medicine, Kasturba Medical College, Manipal University, Karnataka, India;Department of Microbiology, Amrita Institute of Medical Sciences, Cochin. Kerala, India;Department of Microbiology, Kasturba Medical College, Manipal University, Karnataka, India

关键词: tuberculosis;    malignancy;    lymphadenopathy;    mediastinal mass;    melioidosis;   

Others  :  1195991
DOI  :  10.1186/1752-1947-6-28

 received in 2011-09-07, accepted in 2012-01-23,  发布年份 2012

【 摘 要 】

Introduction

Melioidosis, endemic in Thailand and in the Northern Territory of Australia is an emerging infectious disease in India which can present with varied forms. A case of melioidosis, presenting as a rare anterior mediastinal mass which can masquerade as malignancy or tuberculosis, is described here. With treatment, our patient initially showed an increase in the size of mediastinal node and development of new submandibular node.. To the best of our knowledge, this phenomenon has not been documented in the literature and the same is highlighted in this case report.

Case Presentation

A 43-year-old Asian man with diabetes presented with fever, loss of appetite, weight loss for one month and painful swelling below his left mandible for five days. An examination revealed an enlarged left submandibular lymph node and bilateral axillary lymph nodes. A chest X-ray showed mediastinal widening. Computed tomography of his thorax showed a lobulated heterogeneously enhancing anterior mediastinal mass encasing the superior vena cava suggestive of malignancy. An excision biopsy of the lymph node showed granulomas suggestive of tuberculosis but bone marrow culture and lymph node aspirate culture grew Burkholderia pseudomallei. He was treated with parenteral ceftazidime and amoxicillin-clavulanic acid. During the course of treatment, he developed an enlargement of the submandibular lymph node on the opposite side. It gradually subsided with the continuation of therapy orally with a combination of cotrimoxazole and doxycycline for six months. A repeat computed tomography chest scan showed resolution of the mediastinal mass.

Conclusion

Melioidosis can present as a mediastinal mass that mimics tuberculosis or malignancy. During the initial phase oftreatment of melioidosis, the appearance of new lymph nodes or an increase in the size of the existing lymph nodes does not mean treatment failure. Inexperienced clinicians may consider this as treatment failure and may switch treatment. To the best of our knowledge, this is the first report documenting this phenomenon in melioidosis cases.

【 授权许可】

   
2012 Saravu et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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