Melioidosis of Chest Wall Masquerading as a Tubercular Cold Abscess
A 50-year-old male, farmer by occupation, presented to the outpatient department of our hospital with swelling over the left chest for 30 days. He was suspected to have pulmonary tuberculosis by a private practitioner and was started on anti-tubercular treatment for four months when he presented to us. The investigation details for suspected pulmonary tuberculosis were not available with the patient. He had no associated comorbidities like diabetes, hypertension, renal or hepatic disease. On examination, there was a 8 × 4 cm swelling over the left anterior chest associated with erythema and tenderness []. As he was on anti-tubercular therapy and was a suspected case of pulmonary tuberculosis and no investigations were available, we worked him up considering the possibility of tuberculosis. He had neutrophilic leukocytosis with a total leukocyte count of 9900/mm3 with 83% neutrophilis. His ESR was 45 mm at the end of 1 hour. His chest radiograph was normal with no evidence of active or healed pulmonary tuberculosis and there was no evidence of involvement of the ribs underlying the abscess. His fasting blood sugar was 84 mg/dl and serum creatinine was 0.9 mg/dl. Ultrasound abdomen showed no intra-abdominal pathology. Pus was aspirated from a non-dependent area and sent for culture with a diagnosis of tuberculous cold abscess and empirical cloxacillin was started considering the possibility of pyogenic abscess as he had no response to anti-tubercular therapy. But, pus culture on blood and MacConkey agar revealed a growth of Burkholderia pseudomallei, sensitive to ceftazidime, ciprofloxacin, cotrimoxazole and meropenem and it was negative for acid-fast bacilli. Incision and drainage of the abscess was done and he received a 10-day course of intravenous ceftazidime 1 g twice daily. The wound healed completely []. Currently, the patient has completed three months of cotrimoxazole therapy and at three months of follow-up there is no evidence of recurrence.