Case report PNEUMON Pneumon 2023;36(3):20 https://doi.org/10.18332/pne/163487 1 INTRODUCTION Melioidosis is a clinical disease caused by B. pseudomallei, which is endemic in South-East Asia and Northern Australia. The infection is usually acquired through percutaneous inoculation or inhalation of the bacterium present in soil and surface water in the endemic region 1 . Risk factors for melioidosis include diabetes, alcoholism, and chronic renal disease, which are associated with increased mortality. Melioidosis is a great mimicker of many clinical conditions and commonly presents as community-acquired pneumonia (CAP), which is ver worring, as melioidosis present with pneumonia is associated with a high mortality rate 2 . At least 10% of cases present with a chronic respiratory illness, mimicking tuberculosis and ofen with upper lobe infltrates and/or cavities on chest radiography 3 . The proper data on incidence of lower respirator tract infections are not available in India. But as per the WHO report, the mortality rate due to lower respiratory tract infections in individuals aged >65 years is 6.2 per 1000 deaths 4 . Melioidosis is still a rare disease in India where the incidence of CAP and pulmonar tuberculosis is ver high. Since CAP and pulmonar tuberculosis are common conditions managed in primar care settings, it is imperative for doctors to understand the clinical presentation of melioidosis with pulmonar involvement. Timely diagnosis of melioidosis is crucial in preventing mortality. Hence, we report a rare case of melioidosis that presented clinically and radiologically as community-acquired pneumonia. Timely diagnosis and treatment helped in complete recover of the patient. CASE PRESENTATION A 65-year-old farmer from a coastal region of India, who was a known diabetic, presented with a high-grade intermittent fever associated with chills, cough with purulent expectoration, and right-sided dull aching chest pain for 2 weeks. Chest X-ray showed a cavitar consolidation in the right upper lobe. A provisional diagnosis of community acquired pneumonia and pulmonar tuberculosis was made. The patient was started on beta lactams and macrolides. To rule out pulmonar tuberculosis, sputum GeneXpert was done and MTb was not detected. Despite receiving empiric antibiotics as per the guidelines, the patient had persistent fever and a few episodes of mild hemoptysis. Total leukocyte count was 16560/mm 3 , and procalcitonin was 1.1. In view of persistent fever, increased leukocyte count and raised procalcitonin, antibiotics were stepped up to iv piperacillin-tazobactam and iv amikacin. Sputum Culture showed B. pseudomallei, sensitive to piperacillin-tazobactam, cefoperazone-sulbactam, amikacin, ceftriaxone, meropenem, levofloxacin, and resistant to cefazidime, minocycline, amoxycillin/clavulanic acid and, gentamycin. Blood culture was negative. Ultrasound of abdomen was normal. Clinical and laborator results gave a diagnosis of pulmonar melioidosis with no other organ involvement. As culture was sensitive to the antibiotics, the patient was treated with iv piperacillin-tazobactam and iv amikacin for 14 days. Then, the patient was started on oral trimethoprim/ sulfamethoxazole and doxycycline as per guidelines 5 . Symptomatic and radiological improvement was seen within ABSTRACT Melioidosis is a clinical disease caused by inhalation or inoculation of Burkholderia pseudomallei. Pulmonar melioidosis can be easily misdiagnosed as community-acquired pneumonia or tuberculosis, highlighting the importance of early recognition and appropriate treatment. This case report presents a 67-year-old farmer who presented with symptoms of cough, fever and chest pain for 15 days, and was diagnosed with pulmonar melioidosis. B. pseudomallei was isolated from the patient’s sputum, and the chest x-ray showed cavitar consolidation, which is a characteristic feature of melioidosis. The patient was successfully treated with intravenous antibiotics in the acute phase, followed by oral antibiotics for a duration of 3 months in the eradication phase. Published by European Publishing. © 2023 Thorve S. M. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0) Melioidosis: Case report of rare pulmonar infection Swapnil M. Thorve 1 , Harshita Mishra 1 , Siddharth R. Waghmare 1 , Sonal P. Karpe 1 , Jairaj P. Nair 1 AFFILIATION 1 Department of Respirator Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, India CORRESPONDENCE TO Swapnil M. Thorve. Department of Respirator Medicine, Lokmanya Tilak Municipal Medical College, College Building, 1st foor, Sion, Mumbai, 400022, India. E-mail: thorves@yahoo.com ORCID ID: https://orcid.org/0000-0001- 6790-8265 KEYWORDS melioidosis, borkholderia pseudomallei, pulmonar melioidosis Received: 19 Januar 2023 Revised: 14 April 2023 Accepted: 4 May 2023