Mediastinal Lymphadenopathy: Melioidosis Mimicking Tuberculosis

Abstract

Melioidosis has protean manifestations and often mimics other disease processes. We present a case of a gentleman presenting with chronic cough whose initial radiographic findings of a cavitatory lung lesion and mediastinal lymphadenopathy were suggestive of tuberculosis. This case highlights the important role that bronchoscopy and endobronchial ultrasound can play in the diagnosis of melioidosis in patients presenting with mediastinal lymphadenopathy whose initial microbiological findings from sputum are negative for tuberculosis.

Keywords: Melioidosis; bronchoscopy; endobronchial ultrasound; mediastinal lymphadenopathy; tuberculosis.

Fig. 1.

A: A 1.9 × 1.6 cm cavitatory lesion seen in the right lower zone. B: A 1.2 × 1.0 cm cavitatory lesion seen in the lateral-basal segment of the right lung with an adjacent area of traction bronchiectasis. C: 4 enlarged pre-tracheal lymph nodes with hypoattenuate centres, in keeping with necrosis of the lymph nodes. The largest measures 2.6 × 2.1 cm.

Fig. 2.

A: Endobronchial ultrasound showing enlarged precarinal lymph node (LN). B: Fine needle aspiration (arrow) of precarinal lymph node (LN) guided by endobronchial ultrasound. PA—pulmonary artery; Ao—aorta.