Neuromelioidosis – A Misleading Clinical Presentation

This is a case of a young female who initially presented with visual symptoms, diagnosed as optic neuritis, and treated with steroids. She recovered completely with therapy and two days later, she developed left hemiplegia, dysarthria, and a drop in sensorium. Imaging with MRI brain was suggestive of demyelination changes with a possible diagnosis of primary CNS demyelination syndrome. With persistent fever spikes in-hospital and worsening sensorium, meningoencephalitis was also considered a differential. She was treated with empiric antibiotics and steroids. Blood culture grew burkholderia pseudomallaei, giving a definitive diagnosis of neuromelioidosis, a rare cause of meningoencephalitis. We thereby report this case to highlight the unusual presentation of neuromelioidosis masquerading as acute demyelinating encephalomyelitis, a challenging diagnosis for clinicians.