# Pyrexia of Unknown Origin in a Young Male: Unmasking Melioidosis in a Tuberculosis-Endemic Setting

## TL;DR

A young man with persistent fever and weight loss was diagnosed with melioidosis, a rare infection often mistaken for tuberculosis, using advanced imaging and PCR techniques.

## Contribution

Highlights the use of PET-CT and PCR for diagnosing melioidosis in a tuberculosis-endemic region.

## Key findings

- PET-CT identified pulmonary and splenic abnormalities in a patient with pyrexia of unknown origin.
- EBUS-TBNA and PCR confirmed melioidosis caused by Burkholderia pseudomallei.
- Symptoms resolved after targeted antibiotic treatment.

## Abstract

A young male, plantation worker from Southeast Asia, presented with a non-productive cough, intermittent high-grade fever with chills, and significant weight loss over two months. Prior investigations were non-contributory, despite various antibiotics, his symptoms persisted. Physical examination and routine investigations, including an extensive microbiological workup for fever were non-contributory. A positron emission tomography-computed tomography (PET-CT) scan performed for pyrexia of unknown origin (PUO) revealed pulmonary consolidation, mediastinal lymphadenopathy, and splenic microabscesses. Material aspirated via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from the left interlobar lymph node was positive for Burkholderia pseudomallei on conventional nested polymerase chain reaction (PCR), confirming a diagnosis of melioidosis. Following appropriate antibiotic therapy, there was a complete resolution of symptoms. This case underscores the diagnostic challenges and the need for advanced techniques in identifying melioidosis, which can mimic tuberculosis.