Melioidosis Masquerading as a Mediastinal Abscess

Key words: Melioidosis, splenic abscess, mediastinal abscess

A 57-year-old male farmer with type 2 diabetes mellitus, residing in an area where melioidosis is not endemic, presented with a 3-week history of intermittent fever, accompanied by malaise and weight loss. He denied experiencing chest pain, shortness of breath, or hemoptysis. A chest computed tomography (CT) scan revealed a superior mediastinal abscess and multiple splenic abscesses (Figure 1). The blood culture was positive for Burkholderia pseudomallei, confirming the diagnosis of melioidosis, while the tuberculosis test was negative. The bronchoscopy examination revealed no abnormalities. The patient received a 4-week course of intravenous ceftazidime, followed by oral trimethoprim-sulfamethoxazole. A follow-up CT scan revealed that the mediastinal and splenic abscesses had completely resolved.

Figure 1. A computed tomography scan showing (a) superior mediastinal abscess and (b) multiple splenic abscesses.

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Melioidosis can manifest with diverse clinical presentations, including pneumonia, septic arthritis, encephalomyelitis, and internal organ abscesses ⁽¹⁾. Notably, mediastinal abscesses due to melioidosis are uncommon. The Darwin Prospective Melioidosis study found that mediastinal lymphadenopathy/mass was present in 99 out of 1148 patients (8.6%) with culture-confirmed melioidosis ⁽²⁾. The presence of mediastinal and splenic abscesses should raise a strong suspicion of melioidosis, especially in endemic areas.

Article Information

Conflicts of Interest

None

Author Contributions

CYC: Conception and design of the study, acquisition of data, drafting the article, final approval of the version to be submitted.

ORCID iD

Chee Yik Chang: 0000-0002-3104-8168

Informed Consent

Written consent has been obtained from the patient to publish the information, including the photographs.

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