{"id":10948,"date":"2026-04-09T11:49:32","date_gmt":"2026-04-09T11:49:32","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=10948"},"modified":"2026-04-09T11:52:50","modified_gmt":"2026-04-09T11:52:50","slug":"an-atypical-presentation-of-meliodosis-a-case-report","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-april-2026\/an-atypical-presentation-of-meliodosis-a-case-report\/","title":{"rendered":"An atypical presentation of meliodosis – A case report"},"content":{"rendered":"

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Abstract<\/h2>\n

Meliodosis is bacterial infection caused by gram negative bacillus called Burkholderia pseudomallei. It is endemic in tropical and subtropical regions of world. Clinical manifestations can vary which include pneumonia, abscess, joint infection, non-healing ulcer and sometimes severe sepsis requiring ICU admission. This article narrates our encounter with a neuromeliodosis which presents as acute transverse myelitis.<\/p>\n

Introduction<\/h2>\n

The infective pathogen Burkholderia pseudomallei was first recognized in 1911 in rhinosphere and ground water in tropical and subtropical regions. This can cause infections in animals and humans(1)<\/sup>. Entry of organisms into human occur through broken skin or inhalational route. Neuromelioidosis is a rare but severe manifestation of melioidosis caused by Burkholderia pseudomallei, a gram-negative environmental organism endemic to tropical regions such as Southeast Asia and India. Central nervous system (CNS) involvement occurs in approximately 1\u20135% of cases but carries high mortality and neurological sequelae.<\/p>\n

Case presentation<\/h2>\n

A 57 years old female presented to OPD with history of difficulty in using bilateral upper limbs for past 7 days. MRI brain was normal. MRI cervical spine revealed long segment T2w hyperintensity involving cervical spinal cord from C2 to D1- likely inflammatory, longitudinal transverse myelitis. CSF analysis showed inflammatory pattern with lymphocyte predominant leucocytosis with elevated protein. She was started on pulse steroids Inj. Methylpred 500 mg IV BD. Her weakness\u00a0 worsened\u00a0 during\u00a0 hospital\u00a0 stay.\u00a0 She\u00a0 was\u00a0 intubated\u00a0 in\u00a0 view\u00a0 of respiratory muscle weakness. Repeat MRI cervical spine showed progression of disease with involvement of medulla and midbrain superiorly and involvement of dorsal spine inferiorly. She was planned for IV immunoglobulin. But due to logistic issues patient attenders opted for discharge against medical advice. CSF cultures send finally grew Burkholderia pseudomallei, which grew after the patient discharge. Hence it was neuromeliodosis which presented as acute transverse myelitis, a rare presentation.<\/p>\n

Discussion<\/h2>\n

Epidemiology<\/h3>\n

Neuromelioidosis is an uncommon but life-threatening manifestation of infection caused by Burkholderia pseudomallei, an environmental gram-negative bacillus found in soil and surface water. The disease is endemic in regions such as Southeast Asia and northern Australia, with increasing recognition in India, particularly in coastal and tropical zones. Central nervous system (CNS) involvement occurs in a small proportion of melioidosis cases (around 1\u20135%), but it is associated with disproportionately high mortality and morbidity(2). ICU admission is often required due to severe neurological impairment, respiratory compromise, or septic shock.<\/p>\n

Pathophysiology<\/h3>\n

The organism gains entry primarily through:<\/p>\n