Case Report: Ascending Myelo-Encephalitis after a Penetrating Injury to the Foot: An Atypical Case of Neuromelioidosis.
Am J Trop Med Hyg
; 104(4): 1260-1264, 2021 01 11.
Article
in En
| MEDLINE
| ID: mdl-33432905
ABSTRACT
Organisms penetrate the central nervous system (CNS) via three routes. The commonest is the hematogenous route, and other routes include contiguous or penetrating injury or rarely via retrograde axoplasmic route. Although the axoplasmic highway is often used by viruses, only a few bacteria are known to penetrate the CNS via this route. We present a 57-year-old man who developed a penetrating injury while working in a field. Over the next 4 months, he developed pain at the site of the poorly healing wound, which ascended up the right leg and presented as a conus-cauda syndrome. Magnetic resonance imaging (MRI) showed an enhancing intradural intramedullary enhancing lesion in the conus on the right side with cord edema from D11 to L1 level. Extensive evaluation was negative, and he continued to progress to holocord myelitis and developed bilateral corticospinal tract lesions ("tractopathy") in the brain stem and internal capsule. He died after developing a right-sided cerebritis with mass effect. Tissue biopsy from the brain at the time of decompressive craniectomy grew Burkholderia pseudomallei and confirmed a diagnosis of neuromelioidosis (NM). We reviewed the literature for NM, its variable presentations, and the concept of an "infectious tractopathy" and imaging findings which could generate suspicion of this entity.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Foot Injuries
/
Infectious Encephalitis
/
Foot
/
Melioidosis
/
Myelitis
Type of study:
Etiology_studies
Limits:
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Am J Trop Med Hyg
Year:
2021
Document type:
Article
Affiliation country:
India