Spinal melioidosis: a rare presentation

Melioidosis is an emerging infection endemic to tropical countries. Neurological complications of melioidosis are rarely encountered. We report a lady with diabetes mellitus, who had an infective myelopathy secondary to melioidosis. This 40-year-old lady had a clinical picture suggestive of an acute myelopathy with a thoracic (T7) sensory level. Magnetic Resonance Imaging (MRI) revealed a long-segment myelitis with ring-enhancing lesions in the lower cord. She did not respond well to conventional immunosuppression. A blood culture revealed Burkholderia pseudomallei with a high titre of antibodies against the same organism. Even though she was given appropriate antibiotics, she continued to have persistent residual neurological deficits. Prompt initiation of treatment with appropriate antibiotics is vital to reduce residual neurological deficits in these patients. Therefore, the requirement of a high index of suspicion to diagnose melioidosis, as well as the significance of a simple investigation such as a blood culture in the evaluation of a myelopathy is highlighted in our case.