Neurological melioidosis (Burkholderia pseudomallei) in a chronic psychotic patient treated with antipsychotics: A case report

RATIONALE: Neurological melioidosis, an extremely rare condition, is caused by the gram-negative bacterium Burkholderia pseudomallei. If treatment is suboptimal or delayed, this infection can produce diverse clinical symptoms and result in death. PATIENT CONCERNS: A healthy 65-year-old female who had been treated with antipsychotic medication for neurotic depression for over 2 years presented with acute-onset fever, headache, lead-pipe rigidity of all limbs, and delirium. DIAGNOSES: Melioidosis meningitis was diagnosed by performing blood examinations and cerebrospinal fluid analysis and cultures. INTERVENTIONS: Intravenous ceftazidime (2 g/8 h for 3 weeks) was administered in-hospital and 240 mg trimethoprim/1200 mg sulfamethoxazole and 100 mg minocycline twice daily administered out-hospital. OUTCOMES: The patient fully recovered after antibiotic therapy without cognitive deficits and associated neurological complications. LESSONS: Because melioidosis is endemic in Southern Taiwan and the use of antipsychotics might mask the symptoms, physicians dealing with patients from endemic areas with a medical history of antipsychotics should always consider the possibility of neurological melioidosis and provide prompt empirical management to suspicious cases.