Cardiac and mediastinum involvement in Burkholderia thailandensis infection: A case report and literature review

Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is prevalent in Southeast Asia and Northern Australia, presenting various clinical manifestations from asymptomatic to life-threatening infections. Although primarily affecting the lungs, intra-abdominal viscera, and musculoskeletal system, melioidosis can rarely involve the heart and mediastinum, which pose significant diagnostic and therapeutic challenges. Herein, we present the case of a 53-year-old male farmer who presented with persistent fever and chest pain, progressing to pericarditis and cardiac tamponade. Imaging revealed necrotic mediastinal lymphadenopathy and an enhancing pericardium with pericardial effusion. The patient underwent emergency surgical drainage and was treated with intravenous followed by oral antibiotics. Culture confirmed Burkholderia thailandensis, a closely related but less commonly reported species. This report highlights the complexities of diagnosing and managing B. thailandensis, which can mimic aortic disease, tuberculosis, malignancies, and other inflammatory conditions, especially in endemic areas, emphasizing the need for prompt medical and surgical treatment to improve patient outcomes.

The Diagnostic Deceiver: Radiological Pictorial Review of Tuberculosis

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.