A Case of Disseminated Melioidosis With Cerebritis

Abstract

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative, facultative intracellular bacterium. Because melioidosis can mimic many diseases, it requires more advanced laboratory facilities with the necessary expertise and can become an underdiagnosed yet serious infection with high mortality and morbidity. Our patient is a middle-aged male with new-onset uncontrolled type 2 diabetes mellitus who presented with high-grade fever, productive cough and altered mental status. CT thorax showed diffuse middle and lower zone consolidation while MRI brain noted meningitis with cerebritis. Blood culture grew Burkholderia pseudomallei. The patient was started on meropenem for melioidosis, however, no adequate improvement was seen. In view of this inadequate response, parenteral cotrimoxazole was added. Significant improvement was noted and cotrimoxazole was continued for six months.

Keywords: cerebritis; dual antibiotic; india; melioidosis; s: burkholderia pseudomallei.

Figure 1. CT thorax-Coronal section showing a large near-homogenous hyperattenuating area in the left lower lobe with surrounding patchy ground-glass attenuation suggestive of consolidation

Figure 2. MRI brain showing FLAIR hyperintensities along the sulci of the left parieto-occipital region with mild post-contrast enhancement (see arrow)