Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules.
Rodrigo Garcia-Santisteban, Maria Kaufman, Hac-Tu Jacqueline Chung et al.
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Case in brief
A Florida resident without recent international travel presented with fever, pleuritic chest pain, and hypoxia after severe weather. Chest CT showed multiple solid pulmonary nodules, ground-glass opacities, and mediastinal lymphadenopathy. The illness was diagnosed as putatively locally acquired pulmonary melioidosis due to Burkholderia pseudomallei. With stage 3b chronic kidney disease, he received intravenous ceftazidime followed by oral doxycycline monotherapy and achieved full clinical recovery. At 3 months, follow-up imaging showed complete resolution of the nodules.
What made this case unusual
The case combined suspected local acquisition in a non-traveler from Florida with multiple pulmonary nodules and ground-glass opacities, an imaging presentation that can complicate recognition of melioidosis.
Diagnostic / clinical pearl
Consider melioidosis in non-resolving community-acquired pneumonia or significant pulmonary nodules in the Southern United States, even without international travel; severe weather may be a relevant clinical clue.
Why it matters
In this patient with renal impairment, doxycycline was used as an alternative eradication regimen after intravenous ceftazidime, with full clinical and radiographic resolution.