{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:08:34Z","timestamp":1762848514097,"version":"build-2065373602"},"reference-count":19,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,10,22]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:p>\n                    A male fisherman in his late 40s residing in a coastal region of South India, with a 2\u2009year history of diabetes mellitus, presented with breathlessness and chest pain, along with a month-long history of dry cough and low-grade evening fever. Transthoracic echocardiography revealed a large pericardial effusion, and 900\u2009mL of brownish fluid was drained. Given the elevated adenosine deaminase concentration in the pericardial fluid, tuberculous pericarditis was initially suspected. However,\n                    <jats:italic>Burkholderia pseudomallei<\/jats:italic>\n                    was subsequently isolated from the fluid culture, confirming melioidosis. The patient was initiated on appropriate antibiotic therapy but was unable to complete the full treatment course or attend follow-up, leading to recurrence of the pericardial effusion. This case emphasises the importance of microbiological confirmation before initiating anti-tubercular therapy and highlights that melioidosis can present as isolated pericardial effusion without an evident primary focus. The true prevalence of such presentations remains unknown.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-265822","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:05:17Z","timestamp":1762848317000},"page":"e265822","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Melioidosis presenting as isolated pericardial effusion"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4582-0811","authenticated-orcid":false,"given":"Nivedha","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8130-1523","authenticated-orcid":false,"given":"V Anirudh","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vidyalakshmi","family":"K","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narasimha","family":"Pai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"2025111100051330000_18.11.e265822.1","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v3.i5.135"},{"key":"2025111100051330000_18.11.e265822.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-024-04381-1","article-title":"Pericardial effusion in an Indian context: clinical insights and dynamics from a tertiary care centre","volume":"24","author":"Shaik","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"2025111100051330000_18.11.e265822.3","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.18.2.383-416.2005"},{"key":"2025111100051330000_18.11.e265822.4","first-page":"262","article-title":"A hitherto undescribed infective disease in Rangoon","volume":"47","author":"Whitmore","year":"1912","journal-title":"Indian Med Gaz"},{"key":"2025111100051330000_18.11.e265822.5","doi-asserted-by":"crossref","DOI":"10.1002\/rcr2.1119","article-title":"A rare case of melioidosis presenting as pericarditis and pneumonia in a patient with poorly controlled diabetes mellitus","volume":"11","author":"Leung","year":"2023","journal-title":"Respirol Case Rep"},{"key":"2025111100051330000_18.11.e265822.6","doi-asserted-by":"publisher","DOI":"10.1080\/00365540600953487"},{"key":"2025111100051330000_18.11.e265822.7","doi-asserted-by":"publisher","DOI":"10.1378\/chest.69.2.227"},{"key":"2025111100051330000_18.11.e265822.8","doi-asserted-by":"crossref","DOI":"10.3390\/tropicalmed5030121","article-title":"Melioidosis and the Heart: A Systematic Review","volume":"5","author":"Velusamy","year":"2020","journal-title":"Trop Med Infect Dis"},{"key":"2025111100051330000_18.11.e265822.9","doi-asserted-by":"publisher","DOI":"10.1086\/318116"},{"key":"2025111100051330000_18.11.e265822.10","doi-asserted-by":"publisher","DOI":"10.4103\/0255-0857.34767"},{"key":"2025111100051330000_18.11.e265822.11","first-page":"1209","article-title":"Tuberculosis mimicked by melioidosis","volume":"12","author":"Vidyalakshmi","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025111100051330000_18.11.e265822.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2012.02.012"},{"key":"2025111100051330000_18.11.e265822.13","first-page":"39","article-title":"Isolated pericardial effusion in melioidosis","volume":"9","author":"Buragohain","year":"2019","journal-title":"Assam J Intern Med"},{"key":"2025111100051330000_18.11.e265822.14","first-page":"746","article-title":"Melioidosis with a Pericardial Effusion, which Relapsed as a Chest Wall Abscess: A Rare Presentation","volume":"7","author":"Mathai K","year":"2013","journal-title":"JCDR"},{"key":"2025111100051330000_18.11.e265822.15","doi-asserted-by":"crossref","first-page":"116","DOI":"10.18231\/j.ijmmtd.2021.025","article-title":"Melioidosis complicated with pericardial effusion - 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