gms | German Medical Science

Introduction: Neoplasms, autimmune disorders and infectious diseases as differential diagnoses of cervical lymphadenopathies also require the consideration of rare causes.

Case report: A 25-year-old patient presented for further diagnosis and treatment of a colliquating, high febrile cervical lymphadenopathy. The patient from Thailand who had been living in Germany for 8 years reported she worked as rice farmer during the 1980s. Examination showed a vast physical condition with severe weight loss, joint- and swallowing aches which did not respond to high doses of parenteral antibiotic treatment. The histology of a lymph node revealed a necrotizing lymphadenitis, lymphoma were excluded. During further complications (sepsis, splenic and intracerebral abscesses and osteomyelitis) multiple different cytologic samples from lympoid tissue, different wound lesions and brochial secretion microscopically showed non-fermenting, gram-negative rods by 16S-rDNA-analysis identified as Burkholderia cocovenenans/ gladioli. Thus a melioidosis-like diasease (endemic in south east asia) was diagnosed. Responsible for the severe course with a lethal recurrence despite antibiotic treatment was the patients additional immune defect (anti-interferone-γ-autoantibodies)

Summary: Travelling history informations become more and more important considering increasing long-distance travelling and worldwide migration movements. Unclear inflammatory/infectious diseases require early interdisciplinary treatment. Detailed informations for the pathologist facilitate the diagnosis.