Acute septicaemic melioidosis with pulmonary hilar prominence: a case report with a unique chest radiographic pattern.

Acute septicaemic melioidosis with pulmonary hilar prominence: a case report with a unique chest radiographic pattern", In acute septicaemic melioidosis chest radiographs most commonly show nodular densities, upper lobe pneumonitis with cavity formation, and irregular mottled densities with dissemination throughout both lungs. A rarely reported but unique radiographic pattern of bilateral pulmonary hilar prominence in a patient with acute septicaemic melioidosis is described. A triad of pulmonary hilar adenopathy, pyrexia, and suppurative lymphadenitis in a patient with Pseud-omonas pseudomallei bacteraemia is emphasised. Case report A 73-year-old man, a known case of diabetes mellitus, was admitted to hospital on 14 August 1978 with a history of fever and chills for three weeks. When questioned he admitted to slight cough and decreased appetite. On admission he was febrile. There was suppurative lymphadenitis of the right side of the neck and fine rales over the left upper chest. A chest radiograph showed bilateral pulmonary hilar prominence suggestive of tuberculosis (figure). cell count was 9 2X10'/l (86% neutrophils, 2% mono-cytes, 12% lymphocytes). Results of serum electrolyte and blood urea tests were unremarkable. Blood sugar measured 300 mg/dl. He was treated with isoniazid, ethambutol, and streptomycin, which was discontinued after five days because right cervical lymph node biopsy and culture showed no evidence of tuberculosis, but Ps pseudomallei, which was sensitive to amikacin, kanamycin, chloramphenicol, and Septrin. A change to chloramphenicol, 6 g, Septrin, 2 g, and amikacin, 15 g, a day brought clinical response within three days. Three blood culture specimens on 14 August showed the same Ps pseudomallei as from the cervical lymph node. Antibiotics were continued for four weeks. In-vitro and in-vivo cellular immunity evaluation by using E-rosette formation (E) and 2,4 dinitrochloro-benzene reaction (D) in this case showed subnormal values: E-46% and D-negative reaction, as compared with E-77*1-t4 1% and D-80% positive reaction in 20 healthy subjects. Based on the depressed cellular immunity, levamisole, 150 mg was given twice a week for four weeks together with the combined antibiotic treatment. After the immunopotentiation his cellular immunity reached normal levels within two weeks. A Chest radiographs showing bilateral hilar adenopathy. 565