Melioidosis: A rare case of hemoptysis with pseudoaneurysm

Melioidosis, a highly contagious disease, often fatal caused by Burkholderia pseudomallei, a gram negative bacteria, often lurks in water, soil and air and is widely prevalent in India. It is a nightmare to the physician to reach to a substantial diagnosis as it mimics various infections. High variability is seen in the clinical presentation and ranges from acute respiratory illness to chronic debilitating illness with pneumonia being the commonest presentation. Sputum culture remains the gold standard for diagnosing melioidosis. Antibiotics remains the choice of treatment. It often presents as community-acquired pneumonia and sepsis, but can involve almost any part of the body. In this case report, we illustrate a rare but fatal complication of this increasingly reported and important disease. A 61 year old patient, known alcoholic, smoker and a diabetic, presents with low grade fever, night sweats associated with cough and hemoptysis since 10 days to the emergency department. Vitals were stable and chest X-ray revealed right hilar prominence with opacity in upper zone and CT scan reveals right apical segment cavity with pseudoaneurysm and centrilobular nodules. Sputum samples for AFB and malignant cells were negative. Sputum culture showed burkholderia pseudomallei sensitive to ceftazidime and the patient was started on parenteral ceftazidime, continued for 10 days and then shifted to oral ceftazidime and cotrimoxazole for a period of 8 weeks. The condition of the patient gradually improved, hemoptysis stopped in two weeks. After 8 weeks on follow up visit patient was clinically normal. Further studies are necessary to determine the medical, economical impact and their outcomes in endemic population in India.