An uncommon cause of fever in a patient with hyperthyroidism

Area of Science:

• Endocrinology
• Infectious Diseases
• Internal Medicine

Background:

• Fever is a significant clinical symptom indicating various inflammatory processes, including thyroid conditions like Graves' disease.
• Melioidosis, caused by Burkholderia pseudomallei, is an infection prevalent in India, often co-occurring with diabetes mellitus.
• Graves' disease, a form of hyperthyroidism, can present with fever or be associated with thyroid storm.

Observation:

• A patient with Graves' disease presented with a prolonged fever lasting over a month.
• The initial presentation mimicked a thyroid-related inflammatory process.
• The patient was referred by a primary care physician for evaluation of persistent fever.

Findings:

• The prolonged fever in the Graves' disease patient was ultimately diagnosed as melioidosis.
• This case highlights the potential for melioidosis to present atypically in patients with underlying endocrine disorders.
• Burkholderia pseudomallei infection was confirmed in a patient with hyperthyroidism.

Implications:

• Family physicians must maintain a high index of suspicion for melioidosis, especially in endemic areas or in patients with risk factors like diabetes.
• Awareness of melioidosis is crucial as it can affect multiple organs and mimic other conditions.
• Prompt diagnosis and treatment of melioidosis are essential for successful patient outcomes and preventing complications.