EBUS-TBNA diagnosis of mediastinal melioidosis in patient presented with lymphadenopathy and SVC thrombosis: A rare manifestation in non-diabetic patient

Abstract

Melioidosis is a tropical infectious disease that ranks as northeastern Thailand's third most common infectious cause of death. The manifestations of melioidosis vary depending on the organs involved and often resemble malignancy and tuberculosis. We present a case of an atypical melioidosis presentation in a patient with low-grade fever and facial swelling without any risk factors. Chest CT revealed a 3.3-cm heterogeneous enhancing right lower paratracheal lymph nodes with thrombosis of the superior vena cava and azygos vein. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph node was performed, and Burkholderia pseudomallei was identified through lymph node culture. The patient underwent a three-week intravenous course of ceftazidime and a 12-week oral course of trimethoprim-sulfamethoxazole. Oral anticoagulation was also administered. Follow-up computed tomography of the thorax after completion of treatment revealed no residual lymphadenopathy and thrombosis.

Keywords: Atypical melioidosis presentation; Burkholderia pseudomallei; EBUS-TBNA; Mediastinal lymphadenopathy; Mediastinal melioidosis; SVC thrombosis.

Fig. 1

(A and B) The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was conducted on the right paratracheal and subcarinal lymph nodes due to a high risk of malignancy.

Fig. 2

(A and B) Figure A showed a 3.3-cm heterogenous enhancing mediastinal lymph node at the right paratracheal region. Figure B demonstrated complete resolution of right paratracheal lymphadenopathy after treatment.

Fig. 3

(A and B) Figure A revealed intraluminal filling defect in the SVC and azygos vein, resulting in thrombosis on a chest CT scan. Figure B demonstrated complete resolution of SVC thrombosis after complete treatment with standard antibacterial regimen along with anticoagulation.