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Case of the Month 18 December 2016

Case of the Month 18 December 2016. History : 60 -year-old male admitted with fever up to 41 ºC, more than 10kgs weightloss in the past months. Patient had in the past 6 months visited family in South East Asia. Quantiferon test was negative. Case of the Month 18. Case of the Month 18.

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Case of the Month 18 December 2016

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  1. Case of the Month 18 December 2016 History: 60-year-old male admitted with fever up to 41ºC, more than 10kgs weightloss in the past months. Patient had in the past 6 months visited family in South East Asia. Quantiferon test was negative.

  2. Case of the Month 18

  3. Case of the Month 18

  4. Case of the Month 18

  5. Case of the Month 18 What is your diagnosis ?

  6. Case of the Month 18 December 2016 History: 60-year-old male admitted with fever up to 41ºC, more than 10kgs weightloss in the past months. Patient had in the past 6 months visited family in South East Asia. Quantiferon test was negative.

  7. Case of the Month 18 • Consolidation with small cavity in the left lung • Diffuse centrilobular nodules in addition to the large consolidation

  8. Case of the Month 18 Enlarged medistinal lymph nodes with nodal(central) necrosis

  9. Case of the Month 18 Diagnosis Meliodosis Case provided by Anagha Parkar, Bergen, Norway

  10. Case of the Month 18 Discussion • Meliodosis is caused by the Burkholderia pseudomallei, a gram negative, aerobic bacillus • It is endemic in South East Asia • Lung is the most common site for infection • Patients of all ages may be affected, but a peak is observed between 40-60 years • Patients may or may not be immunocompromised • Incubation time may vary from days to months after exposure • Symptoms include fever and weight loss • The diagnosis in this case was suspected due to the exclusion of tuberculosis, extreme weight loss, fever, history of travel to endemic area and the CT findings

  11. Case of the Month 18 Discussion CT • Consolidation with or without cavitation may be seen • If there is a cavity, it rarely shows a air/fluid level • Mediastinal lymphnode enlargement is rare, but when present, it shows central necrosis • The disease maybe multifocal. Unifocal disease may be confused with tuberculosis initially, though there is rarely pleural affection with meliodosis

  12. Case of the Month 18 Discussion • Worldwide distribution of melioidosis. The pink represents the main endemic areas and the blue representsthe sporadicisolates

  13. Case of the Month 18 Further Reading 1. Imaging spectrum of thoracic melioidosis. Ko SF, Kung CT, Lee YW, Ng SH, Huang CC, Lee CH. J Thorac Imaging. 2013 May;28(3):W43-8. doi: 10.1097/RTI.0b013e3182610700. 2.Spectrum of imaging findings in melioidosis. Muttarak M, Peh WC, Euathrongchit J, Lin SE, Tan AG, Lerttumnongtum P, Sivasomboon C.Br J Radiol. 2009 Jun;82(978):514-21. doi: 10.1259/bjr/15785231.

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