Isolation of Burkholderia cepacia complex from pericardial fluid in a patient with lung adenocarcinoma with metastasis: A rare case report.

BACKGROUND

Burkholderia cepacia complex (BCC) comprises environmental non-fermenting Gram-negative bacilli that primarily cause opportunistic infections in immunocompromised individuals. Pericardial infection due to BCC is exceedingly rare, particularly in patients with malignancy. Differentiating infectious from malignant effusions remains a diagnostic challenge, especially in tuberculosis-endemic regions.

CASE PRESENTATION: We report a case of a 50-year-old female presenting with chronic cough, fever, and progressive Grade III dyspnoea requiring oxygen support. Imaging revealed right pleural effusion and pericardial effusion. Cytological examination of pleural fluid demonstrated malignant cells, and immunohistochemistry confirmed lung adenocarcinoma with metastasis. The patient was also HBsAg positive with detectable viral load, representing an additional immunocompromised state.Pericardial fluid culture isolated Burkholderia cepacia complex, while pleural fluid cultures remained sterile. Tuberculosis workup, including Ziehl-Neelsen staining, GeneXpert testing, and adenosine deaminase levels, was negative. Antimicrobial susceptibility testing performed using CLSI 2024 interpretative criteria demonstrated susceptibility to trimethoprim-sulfamethoxazole, levofloxacin, and meropenem; intermediate susceptibility to minocycline; and resistance to ceftazidime. The patient received targeted antimicrobial therapy along with chemotherapy and showed symptomatic improvement with reduced oxygen requirement.

DISCUSSION: Isolation of BCC from a sterile site without prior cardiac intervention raises important questions regarding pathogenesis. Dual immunocompromised states-lung adenocarcinoma with metastasis and chronic hepatitis B infection-likely facilitated opportunistic infection through hematogenous or contiguous spread. Clinical correlation and therapeutic response supported true infection rather than contamination.

CONCLUSIONS

BCC can rarely cause pericardial infection in patients with malignancy. Comprehensive microbiological evaluation of pericardial fluid is essential even in confirmed malignant effusions to enable accurate diagnosis and targeted therapy.