Melioidosis presenting as isolated pericardial effusion

A male fisherman in his late 40s residing in a coastal region of South India, with a 2 year history of diabetes mellitus, presented with breathlessness and chest pain, along with a month-long history of dry cough and low-grade evening fever. Transthoracic echocardiography revealed a large pericardial effusion, and 900 mL of brownish fluid was drained. Given the elevated adenosine deaminase concentration in the pericardial fluid, tuberculous pericarditis was initially suspected. However, Burkholderia pseudomallei was subsequently isolated from the fluid culture, confirming melioidosis. The patient was initiated on appropriate antibiotic therapy but was unable to complete the full treatment course or attend follow-up, leading to recurrence of the pericardial effusion. This case emphasises the importance of microbiological confirmation before initiating anti-tubercular therapy and highlights that melioidosis can present as isolated pericardial effusion without an evident primary focus. The true prevalence of such presentations remains unknown.