Whitmore’s disease mimicking tuberculosis: a clinical pitfall

Melioidosis, caused by Burkholderia pseudomallei, is endemic in Southeast Asia and Northern Australia, with a wide clinical spectrum ranging from acute fulminant septicemia to chronic localized infections. In endemic regions, it may mimic other common infections such as tuberculosis, often leading to misdiagnosis and delayed appropriate treatment. Chronic melioidosis, in particular, can present with prolonged constitutional symptoms and radiographic findings resembling pulmonary or extrapulmonary tuberculosis. We report a case of chronic pulmonary melioidosis in a patient with type 2 diabetes mellitus who was initially misdiagnosed and treated as pulmonary tuberculosis. Despite empirical anti-tubercular therapy, the patient showed no clinical improvement. Blood cultures subsequently confirmed infection with Burkholderia pseudomallei. The patient responded well to intravenous meropenem followed by oral cotrimoxazole, in accordance with current treatment protocols. This case underscores the importance of maintaining a high index of suspicion for melioidosis in patients with treatment-refractory pulmonary infections in endemic areas. Long-term follow-up was not possible as the patient was lost to follow-up.