Jirawat Napat, Sriprasart Thitiwat
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Thailand.
Respir Med Case Rep. 2024 May 27;50:102048. doi: 10.1016/j.rmcr.2024.102048. eCollection 2024.
Melioidosis is a tropical infectious disease that ranks as northeastern Thailand's third most common infectious cause of death. The manifestations of melioidosis vary depending on the organs involved and often resemble malignancy and tuberculosis. We present a case of an atypical melioidosis presentation in a patient with low-grade fever and facial swelling without any risk factors. Chest CT revealed a 3.3-cm heterogeneous enhancing right lower paratracheal lymph nodes with thrombosis of the superior vena cava and azygos vein. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph node was performed, and was identified through lymph node culture. The patient underwent a three-week intravenous course of ceftazidime and a 12-week oral course of trimethoprim-sulfamethoxazole. Oral anticoagulation was also administered. Follow-up computed tomography of the thorax after completion of treatment revealed no residual lymphadenopathy and thrombosis.
类鼻疽是一种热带传染病,是泰国东北部第三大常见的感染性死亡原因。类鼻疽的表现因受累器官而异,常类似于恶性肿瘤和结核病。我们报告一例非典型类鼻疽病例,患者低热、面部肿胀,无任何危险因素。胸部CT显示右主气管旁下3.3 cm不均匀强化淋巴结,上腔静脉和奇静脉血栓形成。进行了支气管内超声引导下经支气管针吸淋巴结活检,并通过淋巴结培养确诊。患者接受了为期三周的静脉注射头孢他啶疗程和为期12周的口服复方新诺明疗程。同时给予口服抗凝治疗。治疗完成后胸部随访计算机断层扫描显示无残留淋巴结病和血栓形成。