The need for vigilance: melioidosis mimicking tuberculosis

Melioidosis, caused by Burkholderia pseudomallei, is often misdiagnosed due to its clinical similarity with tuberculosis and broad-spectrum clinical manifestations. The infection is particularly prevalent in endemic areas, and a high index of suspicion is required for timely diagnosis and treatment.

We report a 50-year-old male construction worker from central India initially diagnosed with presumptive smear-negative tubercular lymphadenitis. Despite anti-tuberculosis treatment, his condition worsened, prompting further investigation. Culture and biochemical tests identified B. pseudomallei, confirming melioidosis. The patient was started on intravenous ceftazidime and later transitioned to oral cotrimoxazole. He showed significant clinical improvement after treatment.

This case underscores the importance of considering melioidosis in the differential diagnosis of patients with lymphadenitis, particularly in areas where the pathogen is endemic. Timely identification and appropriate treatment are crucial for effective management. Heightened awareness of melioidosis is essential to avoid misdiagnosis and ensure optimal outcomes for patients.