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Case report
Melioidosis of the nervous system: atypical presentation of a rare disease in a 48-year-old man
  1. Saif Hamdoon1,
  2. Ian Wilson2,
  3. Simon Smith3 and
  4. Christian Gericke4
  1. 1Department of Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
  2. 2Department of Neurology, Queensland Health, Cairns, Queensland, Australia
  3. 3Department of Infectious Diseases, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
  4. 4Department of Neurology, The Prince Charles Hospital, Chermside, Queensland, Australia
  1. Correspondence to Dr Saif Hamdoon; saif.hamdoon{at}health.qld.gov.au

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.

  • tropical medicine (infectious disease)
  • infection (neurology)
  • spinal cord
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Footnotes

  • Contributors SH, primary author, contributed by writing a draft, getting patient’s consent form, liaising with supervising consultants in the case. IW is the leading consultant neurologist in the management of case from the presentation till transfer to rehabilitation facility. SS revised the Manuscript, and provided input from infectious disease perspective. CG assisted in providing literature sources, and revising manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note This is a case report of a rare presentation of an unusual condition. Melioidosis presentation can mimic several infectious diseases. The diagnosis requires a high index of suspicion in patients living in, or travelling from tropical areas where Melioidosis is prevalent. This manuscript was produced after the patient’s consent. It was reviewed by the co-authors and edited according to their guidance and recommendations. The aim is to raise awareness of the condition amongst clinicians worldwide.

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