B71-01 Beyond Tuberculosis: Disseminated Melioidosis Mimicking Pulmonary Tuberculosis Relapse in a 42-year Old Diabetic Filipino Male

Abstract Introduction Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease in Southeast Asia and northern Australia. Known as “the great mimicker,” it can present similarly to pulmonary tuberculosis, particularly among individuals with diabetes mellitus, the most significant predisposing factor. Prostatic abscess, though uncommon, often indicates disseminated infection. Case Presentation A 42-year-old Filipino man, diabetic for seven years and prior history of treated pulmonary tuberculosis (completed in 2017) presented with fever and vomiting. One month before admission, he was clinically re-treated for tuberculosis relapse using a standard HRZE regimen, with a negative sputum Gene Xpert result. Upon current admission, HIV testing was negative. Sputum and urine cultures both yielded Burkholderia pseudomallei, confirming disseminated melioidosis.Chest computed tomography revealed bilateral upper-lobe fibrotic densities with traction and cystic bronchiectasis, and new left lower-lobe consolidation with cavitations. Abdominal CT demonstrated atrophic pancreas and a lobulated rim-enhancing and near fluid hypoattenuating lesion (approximately 72 cc) at the junction of the prostate and right seminal vesicle, consistent with a prostatic abscess. He was treated with intravenous ceftazidime for two weeks followed by oral cotrimoxazole for two weeks. Multidisciplinary management included Infectious Disease, Pulmonology, Endocrinology, Nutrition, and Physiotherapy services. The patient’s fever resolved, and nutritional status gradually improved. Discussion This case underscores the diagnostic challenges of melioidosis in diabetic individuals within tuberculosis-endemic regions. Diabetes mellitus significantly increases susceptibility to B. pseudomallei infection. The patient’s prior upper-lobe fibrosis likely contributed to the mistaken diagnosis of tuberculosis relapse. Melioidosis frequently involves the lungs but can disseminate to the genitourinary tract, liver, and spleen. Prostatic abscess occurs in up to 18% of male cases. Radiologic overlap with tuberculosis—such as upper-lobe cavitations and nodular infiltrates—often delays diagnosis. Early microbiologic confirmation and targeted antibiotic therapy with an intensive phase and an eradication phase are crucial to reduce relapse and mortality. Conclusion In diabetic patients presenting with presumed tuberculosis relapse or chronic febrile illness, melioidosis should be considered, particularly in endemic areas. Microbiologic confirmation is essential before initiating tuberculosis retreatment. This abstract is funded by: None