Truong Kimberly K, Moghaddam Samer, Al Saghbini Samer, Saatian Bahman
Department of Medicine, University of California Irvine, UC Irvine Medical Center, Orange, CA, USA.
Department of Medicine, Division of Pulmonary and Critical Care, University of California Irvine, UC Irvine Medical Center, Orange, CA, USA.
Am J Case Rep. 2015 May 6;16:272-5. doi: 10.12659/AJCR.893182.
Melioidosis, an infection caused by the gram-negative bacterium Burkholderia pseudomallei, is an important cause of pneumonia, skin infection, sepsis, and death in Southeast Asia and Australia, but is exceedingly rare in North America. Pulmonary melioidosis typically presents as acute bacterial pneumonia or cavitary lung lesions resembling tuberculosis.
We report melioidosis in a 70-year-old active smoker from Mexico with no history of travel to disease-endemic areas. The patient presented with a left supraclavicular abscess and a non-cavitary, left lung mass encasing a pulmonary vein. Incision and drainage of the patient's subcutaneous abscess isolated B. pseudomallei, and fine-needle aspiration of enlarged mediastinal lymph nodes revealed the presence of intracellular gram-negative bacilli with no evidence of malignancy. Biochemical tests determined that the strain the patient acquired from Mexico is identical to only 1 other isolate from Thailand.
This report highlights the blurring epidemiological borders of this organism, its rare presentation mimicking lung malignancy, and an aggressive antimicrobial treatment that resulted in resolution of the patient's symptoms.
类鼻疽是由革兰氏阴性细菌伯克霍尔德菌属假鼻疽杆菌引起的一种感染，是东南亚和澳大利亚肺炎、皮肤感染、败血症及死亡的重要病因，但在北美极为罕见。肺类鼻疽通常表现为急性细菌性肺炎或类似肺结核的空洞性肺部病变。
我们报告了一名来自墨西哥的70岁现患吸烟者的类鼻疽病例，该患者无前往疾病流行地区的旅行史。患者表现为左锁骨上脓肿及包裹肺静脉的左肺非空洞性肿块。对患者皮下脓肿进行切开引流，分离出假鼻疽杆菌，对肿大的纵隔淋巴结进行细针穿刺抽吸，结果显示存在细胞内革兰氏阴性杆菌，无恶性肿瘤证据。生化检测确定患者从墨西哥感染的菌株仅与来自泰国的另1株分离菌相同。
本报告强调了该病原体流行病学边界的模糊性、其罕见的类似肺恶性肿瘤的表现，以及积极的抗菌治疗使患者症状得以缓解。
