CRA2 BREATHING NEW LIFE INTO A FORGOTTEN DISEASE: A CASE OF PULMONARY MELIOIDOSIS

Lee Yih Hoong1, Ing Shan Kai2, Ngu Nga Hung2
1.Medical Department, Kapit Hospital, Sarawak
2.Respiratory Unit, Sibu Hospital, Sarawak

Introduction
Melioidosis, caused by Burkholderia pseudomallei, is an infectious disease transmitted through contaminated soil, air, or water. It commonly affects individuals with poorly controlled diabetes or weakened immune systems. In Kapit, surrounded by the Rajang River and with many working in plantations or dam construction, melioidosis is endemic. We present a case of pulmonary melioidosis in a previously healthy patient.

Case Presentation
A 47-year-old Iban man, with no medical history and a 10-pack-year smoking history, presented with fever and a productive cough for 2 weeks. He also experienced unintentional weight loss of 9 kg over one month. He worked in logging with regular exposure to river water. Physical examination revealed a cachectic man with crepitus over the left upper lung zone. Serial chest X-rays showed worsening consolidation and cavitation in the left upper zone. Sputum culture, blood culture, acid-fast bacilli smear, and sputum TB Genexpert were negative. A CT scan revealed bilateral lung infection with a suspected abscess in the left upper lobe, mild pleural effusion, and multiple liver and splenic microabscesses. Given the diagnostic uncertainty (tuberculosis, bacterial, or fungal infection), a respiratory physician was consulted.

Diagnosis and Treatment
The patient underwent bronchoscopy and alveolar lavage (BAL) under conscious sedation. The bronchoscopy was normal, but BAL culture grew Burkholderia pseudomallei, sensitive to Ceftazidime, Trimethoprim/Sulfamethoxazole, and Augmentin. He was treated with intravenous Ceftazidime for 4 weeks and discharged with oral trimethoprim/sulfamethoxazole.

Outcome
The patient is under regular outpatient follow-up. Serial chest X-rays show significant improvement, and he remains asymptomatic.

Learning Points

  1. Melioidosis can mimic other conditions. Environmental factors should be considered, especially in endemic areas, even in patients without comorbidities.
  2. Bronchoscopy can help obtain better samples when facing diagnostic dilemmas.