Pulmonary Melioidosis mimicking Lung Cancer：A diagnostic challenge

Abstract

BACKGROUND Melioidosis is an infectious disease in tropical and subtropical areas, which can easily lead to septicaemia or even death after infection. Timely and accurate diagnosis is crucial for prognosis. However, in the early stages, clinical symptoms and laboratory tests often lack specificity, leading to frequent misdiagnosis and delayed treatment. The imaging features that mimic malignant lung tumors further contribute to the diagnostic challenges. METHODS A retrospective analysis was conducted on six cases of pulmonary melioidosis disease with the imaging findings resembled lung cancer in Hainan province from 2002 to 2022. These cases were compared and summarized with data from 13 previously reported cases of melioidosis misdiagnosed as lung cancer in the literature. Clinical, laboratory, and radiological features were analyzed to better understand this condition. RESULTS A retrospective analysis of 19 patients with pulmonary nasal disease mimicking lung cancer revealed that 100% of them had a history of contact with an endemic area, and 95% had predisposing risk factors. Clinical presentations and laboratory data showed little differentiation from lung cancer, with 54% of patients experiencing weight loss and 63% presenting with cough. Radiologically, the pulmonary nasal disease mimicked central lung cancer in 16 cases (84%) and peripheral lung cancer in 3 cases (16%). We found that lesions mimicking central lung cancer were characterized primarily by extensive liquefactive necrotic areas and irregular ring enhancement (94%), with the presence of air bubbles within the lesions being relatively common (63%). Lesions mimicking peripheral lung cancer predominantly exhibited irregular ring enhancement and air bubble signs (100%), with 67% of patients showing multifocal nodules. CONCLUSION Infection with pulmonary nasal disease can manifest with clinical and radiological features that mimic lung malignancies, significantly impacting patient prognosis. Important distinguishing features between the two include the presence of patchy necrosis, irregular ring enhancement, and air bubble signs within the lesions. Therefore, when patients have an epidemiological history and present with tumor-like lesions in the lungs, clinicians should maintain a high level of vigilance.