Meliodosis Presenting as Rhombencephalitis with Antiganglioside Antibody Positivity

Graphical abstract
Neena Baby, Minu George, Priyadarsini Malini, Anilkumar Divakar, Devi Kochath Bhanu and Meera Saji

 

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.

Published on: January 20, 2021
doi: 10.17756/jnen.2021-081
Citation: Baby N, George M, Malini P, Divakar A, Bhanu DK, et al. 2021. Meliodosis Presenting as Rhombencephalitis with Antiganglioside Antibody Positivity. J Neurol Exp Neurosci 7(1): 9-14.

 

665
Downloads