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Chest clinic
Images in Thorax
Pulmonary melioidosis with laryngeal involvement: an unusual site of infection
  1. Chew Lip Ng1,
  2. Xuandao Liu1,
  3. Nicholas Jin Hong Tan2,
  4. Vyas Malur Narayan Prasad1,
  5. Pyng Lee3
  1. 1 Department of Ear, Nose & Throat (ENT)–Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
  2. 2 Department of Pathology, National University Hospital, Singapore, Singapore
  3. 3 Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
  1. Correspondence to Dr Chew Lip Ng, Department of Ear, Nose & Throat (ENT)–Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore S609606, Singapore; chew_lip_ng{at}nuhs.edu.sg

https://doi.org/10.1136/thoraxjnl-2017-211046

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    A 42-year-old Malay man presented with cough productive of yellowish sputum, hoarseness and intermittent daily fever associated with chills and rigours for 3 weeks. Apart from previous pulmonary TB in 1994 for which treatment was complete, there were no other comorbidities. The patient was an active cigarette smoker of 20 pack-years, and worked as an outdoor project coordinator frequently in contact with soil during field surveys in gardens. Chest radiograph showed right perihilar consolidation (figure 1A). CT thorax showed mass-like consolidation of the right upper lobe with extensive mediastinal lymphadenopathy (figure 1B). White cell count was 8.8 (range 3.4–11.0×109/L) with neutrophilia 72.2%; blood, sputum and urine for bacterial cultures, as well as sputum for acid fast bacilli smears and TB PCR assay, were negative. Random blood sugar level was 23.0 mmol/L (range 4.0–7.8 mmol/L) and glycated haemoglobin level was 12.1%. Bronchoscopy showed mobile …

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    Footnotes

    • Contributors CLN and XL: conception of the article, literature search, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. NJHT: literature search, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, and final approval of the version to be published. VMNP and PL: conception of the article, literature search, analysis and interpretation of data, revising it critically for important intellectual content, and final approval of the version to be published.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.