SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: localized pulmonary melioidosis is well recognized in many countries in Southeast Asia. Lung cancer is one of the most common malignancy among worldwide population. We report a case which localized pulmonary melioidosis had been diagnosed co-existing with primary lung cancer. CASE PRESENTATION: A 63-year-old Thai male presented with persistent fever and non-productive cough for 3 months. He also described intermittent chest tightness at left hemithorax. He lost his weight for 4 kg in 2 months. He did not respond to 14 days of meropenem. He underwent deceased donor kidney transplantation 4 years ago due to chronic kidney disease. His current immunosuppressive agents were mycophenolate mofitil and cyclosporine. Acyclovir was also prescribed for herpes infection prophylaxis. Physical examination showed an asthenic patient with anicteric sclera. His vital signs were a body temperature of 38oc, blood pressure of 100/60 mm Hg, pulse rate of 90/min and respiratory rate of 17/min. His oxygen saturation was 95% on ambient air. Pulmonary examination revealed decreased breath sounds at left upper lung zone, no crackles or egophony. Other examinations were unremarkable. Complete blood count showed white blood cells of 22 x 109/ml with 91% of neutrophils. Blood level of electrolytes and renal and liver function test remained normal. His chest radiograph showed mass-lesion at left upper lung zone. Chest tomography showed 9.1 cm mass-like opacity with internal hypodensity at anterior segment of left upper lobe. Antibodies titer for Bhurkhoderhia pseudomallei was positive in high titer (1:1,280). Transthoracic core needle biopsy was performed. Pathology showed adenocarcinoma but tissue culture grew for Bhurkhoderhia pseudomallei. DISCUSSION: B. pseudomallei is widely distributed in water and soil. Endemic areas are found in Southeast Asian countries and Australia[1]. Melioidosis may be localized or disseminated in any organ systems. It is called ‘the great mimicker’ because of its variety of signs and symptoms. It can cause acute fatal pneumonia, cavitary lesion mimics reactivation of tuberculosis or mass-like lesion mimics malignancy which can lead to SVC obstruction[2]. The radiological findings seen in pulmonary melioidosis is lobar or segmental consolidation, pulmonary nodules with cavity and pleural effusion consecutively[3]. Mass-like lesion can be seen in a case report. CONCLUSIONS: To the best of our knowledge, this is the first case report which localized pulmonary melioidosis is founded co-existing with primary lung cancer. Reference #1: Ip, M., et al., Pulmonary melioidosis. Chest, 1995. 108(5): p. 1420-4. Reference #2: Wilson, M., et al., Melioidosis mimicking primary lung malignancy with superior vena cava obstruction. IDCases, 2016. 6: p. 58-59. Reference #3: Maneechotesuwan, K., An exotic pulmonary infection in Thailand: melioidosis. Respirology, 1999. 4(4): p. 419-22. DISCLOSURES: No relevant relationships by gunthiga laplertsakul, source=Web Response No relevant relationships by Tananchai Petnak, source=Web Response