Coinfection of Mycobacterium tuberculosis and Burkholderia pseudomallei or Melioidosis Masquerading as Tuberculosis in an Immune Competent Host: A Diagnostic Challenge

In this case report, we discuss a rare presentation of dual infection with M. tuberculosis and B. pseudomallei in an immunocompetent host, reinforcing the importance of adopting a broad diagnostic perspective in endemic settings in guiding effective therapy. IntroductIonTuberculosis (TB) is an infectious disease caused predominantly by Mycobacterium tuberculosis.Occasionally, organisms like Mycobacterium bovis and Mycobacterium africanum are also involved in the pathogenesis of the disease, which can affect any organ except hair and nails. 1 Of the world population, 23% (1.7 billion) are infected with TB, and 10.6 million have the active disease, among which 56% are males. 2Sri Lanka, however, is considered to be endemic for TB, and the Western Province, being the region with the highest caseload, with regard to global epidemics, is proposed as a low-burden country for TB.Melioidosis, termed a "great mimicker of TB," is an infectious disease caused by Burkholderia pseudomallei, a gram-negative bacillus abundant in soil and water in certain tropics and subtropics. 3he annual global incidence is >1,65,000 cases, with Southeast Asia and Northern Australia bearing the highest caseloads. 4oinfections involving TB and melioidosis are exceedingly rare but clinically significant, particularly in regions that carry endemicity for both.Prolonged fever, constitutional symptoms, respiratory involvement, and radiographic abnormalities are overlapping features shared by both infections, presenting as a major diagnostic dilemma.Even though immunocompromised states predispose to poor prognostic outcomes in patients with TB or melioidosis, the presence of coinfection in the absence of immune dysregulation is extremely rare.