Parietal bone osteomyelitis in melioidosis

Area of Science:

• Infectious Diseases
• Neurology
• Radiology

Background:

• Melioidosis is a serious infection caused by Burkholderia pseudomallei, often presenting with pneumonia.
• Uncontrolled diabetes is a significant risk factor for severe melioidosis infections.

Observation:

• A 55-year-old man with uncontrolled diabetes presented with pneumonia and clinical deterioration.
• The patient experienced a focal seizure, and MRI revealed central nervous system involvement and parietal bone osteomyelitis.
• Blood cultures and endotracheal aspirate identified Burkholderia pseudomallei, confirming a diagnosis of melioidosis.

Findings:

• Initial treatment with ceftazidime was unsuccessful.
• The patient was switched to meropenem, leading to gradual clinical improvement over four weeks.
• Cerebral and bone involvement complicated the presentation of melioidosis.

Implications:

• This case underscores the critical need for early recognition and appropriate antimicrobial therapy in suspected melioidosis.
• Prompt diagnosis and effective treatment, such as with meropenem, are crucial for favorable outcomes in complex melioidosis cases.
• Central nervous system and osteomyelitis are severe manifestations of melioidosis that require aggressive management.