Neurological melioidosis complicated by cerebral venous sinus thrombosis

P K Abeysundara,M Umakanth,R Premaratna,R M P M Rathnayaka,Y Tilakaratne,R Piyarathne,H De Silva,A A N Nishad,K Arulmoly,W N M Perera

doi:10.4038/jccp.v51i2.7907

Abstract

Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral venous sinus thrombosis. Occurrence of these neurological manifestations in melioidosis is rare and it is a difficult condition to diagnose and treat. Timely diagnosis was a challenge in this patient due to the atypical presentation and the use of empirical antibiotics in the primary care setting. Limited laboratory diagnostic capability also contributed to this delay.

Highlights

Melioidosis is an infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water.[1]
Central nervous system (CNS) melioidosis accounts for only 3-5% of the cases but carries a high mortality of up to 25%, compared to the overall mortality of 7% for systemic melioidosis.[4]
CNS melioidosis can present as meningitis, encephalitis, brain abscesses, subdural empyema, or skull osteomyelitis

Summary

Introduction

Melioidosis is an infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water.[1]. A 69-year-old businessman with poorly controlled type 2 diabetes mellitus presented with intermittent high-grade fever with chills for three weeks He noticed multiple painful lumps on his scalp, generalized headache, intractable vomiting, weight loss and poor appetite. Non-contrast computerized tomography (CT) scan of brain was unremarkable He had an initial clinical response for empirical treatment with intravenous meropenem 1 g 8 hourly and vancomycin 1 g 12 hourly. Repeat IHA carried out in the 3rd week of hospital stay showed a rising titer of 1:1200 confirming the diagnosis of acute melioidosis. Scalp abscesses were healed at three weeks and patient showed a complete recovery by the end of eradication phase. MRI brain was not performed to assess the resolution of the brain abscesses

Findings

Discussion

Conclusion