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

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

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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.

Original languageEnglish
Article number28
JournalJournal of Medical Case Reports
Volume6
DOIs
Publication statusPublished - 24-01-2012

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Melioidosis
Lymph Nodes
Neoplasms
Tuberculosis
Thorax
Treatment Failure
Tomography
Northern Territory
Burkholderia pseudomallei
Emerging Communicable Diseases
Therapeutics
Amoxicillin-Potassium Clavulanate Combination
Superior Vena Cava
Ceftazidime
Doxycycline
Sulfamethoxazole Drug Combination Trimethoprim
Appetite
Thailand
Granuloma
Lymph Node Excision

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Saravu, Kavitha ; Mukhopadhyay, Chiranjay ; Eshwara, Vandana Kalwaje ; Shastry, Barkur Ananthakrishna ; Ramamoorthy, Kundapura ; Krishna, Sushma ; Sathyanarayanan, Vishwanath. / Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy : A case report. In: Journal of Medical Case Reports. 2012 ; Vol. 6.
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Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy : A case report. / Saravu, Kavitha; Mukhopadhyay, Chiranjay; Eshwara, Vandana Kalwaje; Shastry, Barkur Ananthakrishna; Ramamoorthy, Kundapura; Krishna, Sushma; Sathyanarayanan, Vishwanath.

In: Journal of Medical Case Reports, Vol. 6, 28, 24.01.2012.

Research output: Contribution to journalArticle

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T1 - Melioidosis presenting with mediastinal lymphadenopathy masquerading as malignancy

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AU - Saravu, Kavitha

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