CTICasesBurkholderia gladioli Pneumonia in a Heart Transplant Recipient
[...]. Burkholderia gladioli Pneumonia in a Heart Transplant Recipient. CTICases. Published September 11, 2026. https://cticases.com/c/8cef5
Imaging findings
A long-standing heart transplant recipient with a defibrillator had an elevated right hemidiaphragm, with the anterior portion also elevated on the lateral view, and a left lower lobe consolidation on the radiograph. CT showed a masslike consolidation somewhat larger than the preceding case with more surrounding satellite nodules and the same halo of ground glass opacity, solid throughout with nothing else of note. The right hemidiaphragm was markedly thinned and atrophic with fat speckling within the residual muscle, while the left crus appeared preserved, together suggesting chronic right phrenic nerve dysfunction. Bronchoscopy grew Burkholderia gladioli.
Key takeaways
The halo-surrounded mass in a transplant recipient is not organism specific. Shown back to back with a nocardiosis case of near-identical appearance, this one turned out to be an opportunistic gram-negative rod, so fungi, Nocardia and gram negatives all belong on the list and only culture separates them. Burkholderia gladioli is an uncommon opportunist distinct from the better-known Burkholderia cepacia. Separately, diaphragmatic atrophy accompanied by fatty infiltration of the muscle is a more convincing sign of chronic phrenic denervation than thinning alone, because steatosis indicates the muscle is failing rather than simply thin.
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