Pulmonary melioidosis mimicking lung cancer: a diagnostic challenge

Trans R Soc Trop Med Hyg. 2025 Feb 4;119(2):125-134. doi: 10.1093/trstmh/trae089.

Abstract

Background: The overlapping clinical and radiographic features of pulmonary melioidosis and lung cancer present diagnostic challenges to healthcare providers in endemic settings.

Methods: We compared the clinical, laboratory and imaging characteristics of 19 pulmonary melioidosis cases with those of 15 cases of small cell lung cancer (SCLC) and 17 cases of non-small cell lung cancer (NSCLC).

Results: Compared with SCLC/NSCLC cases, those with pulmonary melioidosis were more likely to have diabetes, have fever, neutrophilia and leukocytosis on presentation (p<0.05). While certain CT imaging features were shared between pulmonary melioidosis and SCLC ('frozen mediastinum sign', 'vascular encasement sign'), extensive liquefactive necrosis, uneven ring-enhancement, circular lesions and 'air-bubble' signs were more commonly seen in pulmonary melioidosis cases than in those with SCLC/NSCLC (p<0.05).

Conclusions: Despite the similarities in presentation of pulmonary melioidosis, SCLC and NSCLC, several clinical, laboratory and imaging factors may help delineate these diagnoses and improve patient care.

Keywords: Burkholderia pseudomallei; melioidosis; pulmonary malignancy; pulmonary mass.

MeSH terms

  • Adult
  • Aged
  • Burkholderia pseudomallei / isolation & purification
  • Carcinoma, Non-Small-Cell Lung* / diagnosis
  • Carcinoma, Non-Small-Cell Lung* / diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Humans
  • Lung Neoplasms* / diagnosis
  • Lung Neoplasms* / diagnostic imaging
  • Male
  • Melioidosis* / diagnosis
  • Melioidosis* / diagnostic imaging
  • Middle Aged
  • Small Cell Lung Carcinoma* / diagnosis
  • Small Cell Lung Carcinoma* / diagnostic imaging
  • Tomography, X-Ray Computed