Mediastinal melioidosis: A case series from far North Queensland

Melioidosis is the clinical disease caused by the Gram-negative bacillus Burkholderia pseudomallei and is endemic to Northern Australia and Southeast Asia. It is commonly referred to as the 'great mimicker' because of its wide range of clinical presentations, often making diagnosis challenging. Isolated mediastinal lymphadenopathy as the presenting feature of melioidosis is rare and can be indistinguishable from tuberculosis or malignancy. Endobronchial ultrasound (EBUS) is the preferred technique for evaluating undifferentiated mediastinal lymphadenopathy but its role in the diagnosis of mediastinal melioidosis remains sparsely reported in the literature. In this case series, we present four cases of mediastinal melioidosis, and the role that EBUS guided fine needle aspiration (FNA) played in the diagnosis and management.