Pulmonary melioidosis mimicking lung cancer: a diagnostic challenge

Abstract

Background The overlapping clinical and radiographic features of pulmonary melioidosis and lung cancer present diagnostic challenges to healthcare providers in endemic settings. Methods We compared the clinical, laboratory and imaging characteristics of 19 pulmonary melioidosis cases with those of 15 cases of small cell lung cancer (SCLC) and 17 cases of non-small cell lung cancer (NSCLC). Results Compared with SCLC/NSCLC cases, those with pulmonary melioidosis were more likely to have diabetes, have fever, neutrophilia and leukocytosis on presentation (p<0.05). While certain CT imaging features were shared between pulmonary melioidosis and SCLC (‘frozen mediastinum sign’, ‘vascular encasement sign’), extensive liquefactive necrosis, uneven ring-enhancement, circular lesions and ‘air-bubble’ signs were more commonly seen in pulmonary melioidosis cases than in those with SCLC/NSCLC (p<0.05). Conclusions Despite the similarities in presentation of pulmonary melioidosis, SCLC and NSCLC, several clinical, laboratory and imaging factors may help delineate these diagnoses and improve patient care.