Melioidosis is caused by Burkholderia pseudomallei, water-and-soil gramnegative bacteria predominantly found in Southeast Asia and Australia. Herein, we reported a 63-year-old Thai man presenting with prolonged fever, non-productive cough, and weight loss for 3 months. He underwent deceased donor kidney transplantation 4 years ago and was on many immunosuppressive agents after transplantation. At presentation, his chest radiograph showed a mass-like lesion in the left upper lobe. Histopathological examination of a transthoracic needle lung biopsy yielded adenocarcinoma, while tissue culture grew for B. pseudomallei. He was diagnosed with stage IIIA non-small cell lung cancer (T4N0M0) co-existing with localized pulmonary melioidosis. After intensive and eradication therapy for melioidosis, his well-being improved with the resolution of fever. He sequentially underwent left upper lobectomy, but the procedure was not accomplished due to severe adhesions surrounding the left lung and great vessels. After surgery, he received concurrent chemoradiation therapy for his lung cancer. Nevertheless, the disease progressed, and he finally passed away. Since fever is not a common manifestation of lung cancer, co-existing infection, such as tuberculosis, fungal infection, and melioidosis, should always be excluded in patients suspected of having lung cancer presenting with unexplained fever.

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Background: Sepsis or septic shock results in the alteration of blood flow at the microcirculatory level, affecting tissue oxygenation and organ function and associated with death. This study aimed to use near-infrared spectroscopy (NIRS) in conjunction with vascular occlusion test (VOT) to assess the association of microcirculatory dysfunction after recovered from septic shock and in-hospital mortality. Methods: We conducted a prospective observational study in patients who recovered from septic shock. We performed NIRS with VOT within 24 hours of hospitalization in medical and anesthetic ICU (T0), then at the time of recovery from septic shock (D0), at day 3 (D3), day 5 (D5), and day 7 (D7) after recovery from septic shock. We recorded the de-oxygenation (DeO2) slope, the re-oxygenation (ReO2) slope, and the area under the hyperemic response curve (the reperfusion area). We focused on parameters of microcirculation dysfunction, in-hospital mortality, and in-hospital complications. Hypothesis: We hypothesize that NIRS with vascular occlusion test parameters are associated with in-hospital mortality and hospital complications Ethic: The study protocol has been approved by the Institution Review Board of Ramathibodi Hospital, Mahidol University, Thailand (No. MURA2020/147). Trial registration: TCTR20220413001