Multidrug-resistant <i>Burkholderia pseudomallei</i> pneumonia misdiagnosed as tuberculosis: A case report

Burkholderia pseudomallei is a Gram-negative bacterium commonly found in coastal regions and is usually contracted through contact with contaminated water or soil. This report describes a case of chronic Burkholderia pseudomallei pneumonia in a 54-year-old male, initially misdiagnosed as pulmonary tuberculosis at an external hospital and resistance to treatment based on in vitro drug susceptibility testing. The patient experienced recurrent cough and pulmonary nodules for over 1 year, with symptoms temporarily alleviated by oral anti-infective drugs but recurring repeatedly. In April 2023, the patient presented with worsening cough and fever. A chest computed tomography (CT) scan revealed multiple bilateral lung nodules. Despite treatment with broad-spectrum antibiotics, the lung lesions progressed, leading to a presumptive diagnosis of tuberculosis at the local hospital. Further evaluation at Zhuzhou Hospital Affiliated to Xiangya School of Medicine confirmed Burkholderia pseudomallei through culture of bronchoalveolar lavage fluid and biopsy samples. Initial treatment based on drug susceptibility testing with doxycycline and amoxicillin-clavulanate showed poor efficacy. The regimen was switched to trimethoprim-sulfamethoxazole, resulting in a complete recovery. The patient faced significant treatment challenges due to a family history of severe sulfa drug allergy and personal drug resistance. This case underscores the importance of clinical vigilance regarding potential drug resistance in similar situations.