Pulmonary melioidosis mimicking lung cancer: a diagnostic challenge

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.