Melioidosis mimicking tuberculous pericarditis: A rare case report

Melioidosis caused by Burkholderia pseudomallei is an emerging tropical infection that frequently mimics tuberculosis in endemic regions, resulting in diagnostic delay and inappropriate therapy. We report a 50-year-old man with poorly controlled type 2 diabetes mellitus who presented with fever, abdominal distension, cough, and constitutional symptoms. Imaging revealed bilateral pleural effusion, moderate pericardial effusion, and minimal ascites, leading to an initial diagnosis of disseminated tuberculosis and empirical initiation of antitubercular therapy. Pericardial fluid analysis demonstrated markedly elevated adenosine deaminase (ADA) levels (122 IU/L), further favoring the presumptive diagnosis of tuberculosis. However, despite treatment, the patient developed worsening pericardial involvement. Pericardiocentesis yielded purulent fluid, and cultures from two separate samples grew B. pseudomallei , confirming melioidotic purulent pericarditis. Antitubercular therapy was discontinued, and the patient improved following drainage and targeted antimicrobial therapy with meropenem and cotrimoxazole. This case highlights melioidosis as an important differential diagnosis in diabetic patients with multiserosal effusions and elevated ADA levels, emphasizing the importance of microbiological confirmation before initiation of prolonged antitubercular therapy.