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Parietal bone osteomyelitis in melioidosis.

Hariprasad Sadanand Shetty1, Ajay Raj Mallela1, Barkur Ananthakrishna Shastry2

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A man with uncontrolled diabetes developed pneumonia and a seizure, later diagnosed with melioidosis caused by Burkholderia pseudomallei. Prompt treatment with meropenem led to recovery, highlighting the importance of early diagnosis and therapy.

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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.