Encephalomyelitis as a rare presentation of melioidosis

Cerebral melioidosis is a rare entity which is minimally reported in literature, having multiple diagnostic challenges as it mimics most of the other diseases of the central nervous system (CNS). Spectrum of CNS melioidosis depends on the entry of the organism and immune status of the patient. Due to the delay in diagnosis, it has a high morbidity and mortality. It is thought to be a disease of the immunocompromised with risk of exposure to soil or surface water. We present a case of an immunocompetent patient without any known risk factors for significant exposure, who presented with fever and rapidly progressive multiple cranial nerve palsies followed by reduced level of consciousness and cerebellar signs. She was eventually diagnosed to have encephalomyelitis, a form of neuro melioidosis, with radiological evidence of acute demyelinating encephalomyelitis, and successfully treated with parenteral meropenem for intensive phase and cotrimoxazole for a long eradication phase. High index of suspicion and early initiation of treatment with suitable antibiotics for an optimal duration, evidenced complete recovery.