Meliodosis Presenting as Rhombencephalitis with Antiganglioside Antibody Positivity

Abstract

Background: Neuromelioidosis is a rare infection caused by Burkholderia pseudomallei with a predilection for brainstem involvement. The association of anti-ganglioside antibody positivity with neuromeliodosis has not been reported in literature so far. Methods:We present a case of a 53-year-old woman with neuromeliodosis presenting as rhombencephalitis, with lesions later extending via the white matter tracts along with secondary demyelination. Her evaluation showed a strong positivity for anti-ganglioside antibodies. She was treated with antibiotics and other supportive measures. During the initial clinical deterioration phase, plasma exchange was done. Later, in view of slow response, stereotactic brain biopsy was done and the culture specimen grew Burkholderia psuedomallei. The association of anti-ganglioside antibody positivity also supports the initial response to immune mediated therapy. Conclusion:Neuromeliodosis has a predilection for brain stem involvement with a high propensity to involve and spread along the white matter tracts. The presence of high titres of antiganglioside antibody may give a clue when there is difficulty to isolate the organism from CSF. High index of suspicion is very important for a better outcome.

Neuromelioidosis Presenting as Bells Palsy in a Child

“…[ 11 ] The peculiarity of neuro melioidosis is the absence of CSF spillage of the organism as the organism is largely confined to the white matter fiber tracts; thus, isolation from CSF may not always be possible. [ 12 ] Blood and CSF cultures were sterile in our patient, probably due to low sensitivity and prior antibiotic therapy. The indirect hemagglutinin assay (IHA) is not reliable for diagnosis because of its problematic false positive and false negative results[ 13 ] and hence not done in our patient.…”