Pulmonary Melioidosis Masquerading as Tuberculosis: A Case Report

Tuberculosis is most common chronic lung infection in India and it will present radiologically from nodules with branching lines called as 'tree in bud' to consolidations. Radiological presentations in various chronic lung diseases are overlapping and microbiological confirmation is must rather than giving empirical ant-tuberculosis treatment. Melioidosis is bacteriological infection causing similar clinical and radiological syndrome mimicking tuberculosis. In this case report, 70-year female presented with chronic respiratory illness with constitutional symptoms like cough, low grade fever, weight loss and anorexia and HRCT thorax imaging showing progressive pathologies as tree in bud to consolidations over 3 months duration. She had received anti-tuberculosis treatment empirically for 3 months and was having clinical and radiological deterioration. Bronchoscopy guided bronchoalveolar lavage (BAL) analysis for Gene Xpert MTB/RIF and Bacterial culture suggestive of Melioidosis as cause for her chronic respiratory illness. She was treated as per antibiotic protocol for Melioidosis and shown complete clinical and radiological response.