Melioidosis of the nervous system: atypical presentation of a rare disease in a 48-year-old man. Issue 11 (3rd November 2020)

• Record Type: Journal Article
• Authors: Hamdoon, Saif; Wilson, Ian; Smith, Simon; Gericke, Christian
• Is Part Of: BMJ case reports. Volume 13:Issue 11(2020)
• Publication Date: 2020-11-03
• Subjects: tropical medicine (infectious disease) -- infection (neurology) -- spinal cord; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-233498
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 48-year-old man who worked in mining in remote, northern Australia was transferred from a rural hospital 5 days after the onset of headaches, subjective fevers and flaccid paralysis of the left upper limb. Initial investigations demonstrated inflammatory cerebrospinal fluid (CSF) changes and a longitudinally extensive cervical cord lesion. Given two serial negative blood and CSF cultures, he was treated as inflammatory myelitis with intravenous methylprednisolone. Despite the initial improvement in pain and left arm power, the patient's neurological deficit plateaued and then deteriorated with worsening neck pain, diaphragmatic dysfunction and dysphagia requiring intubation and respiratory support. A third CSF culture isolated Burkholderia pseudomallei confirming a diagnosis of neuro-melioidosis. Repeat imaging revealed the rostral extension of the original spinal cord lesion into the medulla and pons. Over the next 4 weeks, the patient's neurological deficits slowly improved with continued intravenous antibiotic therapy with meropenem and oral trimethoprim/sulfamethoxazole.