Melioidosis: Missed opportunities and opportunistic pathogens

Area of Science:

• Infectious Diseases
• Rheumatology
• Pulmonology

Background:

• Systemic Lupus Erythematosus (SLE) and lupus nephritis can present with diverse pulmonary manifestations.
• Diffuse alveolar hemorrhage (DAH) is a serious complication, often treated with immunosuppression.

Observation:

• A patient with active SLE and lupus nephritis presented with hemoptysis and lung lesions.
• Initial presentation mimicked DAH, but subsequent symptoms and cultures revealed melioidosis.

Findings:

• Chest imaging showed macronodular lesions with a halo sign.
• Bronchoalveolar lavage was positive for hemosiderin-laden macrophages but negative for fungal or bacterial pathogens.
• Blood cultures ultimately identified Burkholderia pseudomallei, confirming melioidosis.

Implications:

• Melioidosis should be considered in the differential diagnosis of pulmonary lesions in SLE patients, especially in endemic areas.
• Prompt diagnosis and appropriate antimicrobial therapy are crucial for favorable outcomes.
• CT-guided lung biopsy may aid in earlier diagnosis when standard cultures are negative.