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Saravu K, Mukhopadhyay C, Eshwara VK, et al. Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report. J Med Case Rep. 2012;6:28doi: 10.1186/1752-1947-6-28.
Saravu, K., Mukhopadhyay, C., Eshwara, V. K., Shastry, B. A., Ramamoorthy, K., Krishna, S., & Sathyanarayanan, V. (2012). Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report. Journal of medical case reports, 628. https://doi.org/10.1186/1752-1947-6-28
Saravu, Kavitha, et al. "Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report." Journal of medical case reports vol. 6 (2012): 28. doi: https://doi.org/10.1186/1752-1947-6-28
Saravu K, Mukhopadhyay C, Eshwara VK, Shastry BA, Ramamoorthy K, Krishna S, Sathyanarayanan V. Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy: a case report. J Med Case Rep. 2012 Jan 23;6:28. doi: 10.1186/1752-1947-6-28. PMID: 22269609; PMCID: PMC3295726.
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J Med Case Rep. 2012 Jan 23;6:28. doi: 10.1186/1752-1947-6-28.

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

Journal of medical case reports

Kavitha Saravu, Chiranjay Mukhopadhyay, Vandana Kalwaje Eshwara, Barkur Ananthakrishna Shastry, Kundapura Ramamoorthy, Sushma Krishna, Vishwanath Sathyanarayanan

Affiliations

  1. Department of Internal Medicine, Kasturba Medical College, Manipal University, Karnataka, India. [email protected].

PMID: 22269609 PMCID: PMC3295726 DOI: 10.1186/1752-1947-6-28

Abstract

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 of treatment 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.

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