Pulmonary Melioidosis Masquerading As Tuberculosis: A Case Report Presenting a Rare Medical Condition From Western India

A young adult from a rural region of Western India developed a two-week history of intermittent fever with evening temperature spikes, dry cough, and systemic symptoms, highlighting a clinical scenario frequently encountered in endemic areas. Examination revealed crackles on the left side of the chest. Investigations revealed thrombocytopenia, mild transaminitis, and bilateral pulmonary infiltrates on chest X-ray. High-resolution computed tomography of the chest showed cavitary consolidation resembling pulmonary tuberculosis (TB), but bronchoalveolar lavage was negative for TB. Despite empirical antibiotics, the patient remained febrile. On the sixth day since admission, blood culture identified <i>Burkholderia pseudomallei</i>, confirming melioidosis bacteremia. In an endemic TB setting, this case highlights the diagnostic challenge between TB and melioidosis and underlines the importance of microbiological confirmation to guide appropriate therapy.