Multi-systemic melioidosis mimics malignancy: A radiological case report

Melioidosis is often referred to as “the great imitator,” and it is more likely to be misdiagnosed when multiple systems are involved. This report describes a patient with an 11-year history of diabetes with poor blood glucose control, a history of heavy smoking, and multi-systemic diseases including lung nodules, multiple enlarged mediastinal lymph nodes, bone destruction and soft-tissue swelling in the proximal right tibia, and intracerebral lesions. Computed tomography (CT) of the lung and tibia and head magnetic resonance imaging with enhanced magnetic resonance spectroscopy led to a misdiagnosis of lung cancer with metastasis to the brain and proximal tibia. The patient was admitted to the hospital on January 17, 2012 and hospitalized for 51 days. He was in stable condition but was not cured and requested to be discharged voluntarily. Head and lung CT was repeated on July 28, 2016. Although the patient's family members reported that he had not received regular treatment in the hospital, his intracerebral lesions, chest lesions, and right calf lesions had all improved. This case indicates that even when medical imaging is consistent with multi-systemic malignancy, imaging must be combined with clinical and laboratory tests to exclude the possibility of melioidosis.