Atypical cardiac melioidosis masquerading as a right atrial mass: a case report

The incidence of melioidosis, a disease caused by Burkholderia pseudomallei, has been increasing in India over the past decade. Cardiac melioidosis is a rare complication of melioidosis, which typically presents as pericarditis, myocarditis, or endocarditis. We report a very rare and probably the first of its kind presentation of cardiac melioidosis as a right atrial mass. A 24-year-old man presented with fever, cough with expectoration, and right-sided multiple joint pain. Burkholderia pseudomallei was isolated from blood cultures, and culture-specific antibiotic treatment was started accordingly. Echocardiography and computed tomography (CT) images incidentally revealed a right atrial mass extending from the inferior vena cava (IVC) and prolapsing into the right ventricle through the tricuspid valve. The patient was planned for excision of the right atrial mass through median sternotomy. Intraoperatively, the mass was found to be an encapsulated pus-filled sac mimicking a right atrial thrombus. Upon histopathological analysis of the specimen and microbiological culture of the exudate, the final diagnosis of a rare variant of cardiac melioidosis was made. He was successfully operated on and treated with meropenem postoperatively during his hospital stay until blood cultures reported sterile. He was discharged with co-trimoxazole as maintenance therapy on regular follow-up as an outpatient. This clinical case adds cardiac melioidosis as a potential differential diagnosis for intracardiac mass, posing diagnostic challenges-requiring a high index of suspicion, culture confirmation, and appropriate imaging with combined surgical intervention and medical management for accurate diagnosis and effective management.

The online version contains supplementary material available at 10.1007/s12055-026-02187-8.