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Despite the initial improvement in pain and left arm power, the patient\u2019s neurological deficit plateaued and then deteriorated with worsening neck pain, diaphragmatic dysfunction and dysphagia requiring intubation and respiratory support. A third CSF culture isolated <jats:italic>Burkholderia pseudomallei<\/jats:italic> confirming a diagnosis of neuro-melioidosis. Repeat imaging revealed the rostral extension of the original spinal cord lesion into the medulla and pons. Over the next 4 weeks, the patient\u2019s neurological deficits slowly improved with continued intravenous antibiotic therapy with meropenem and oral trimethoprim\/sulfamethoxazole.<\/jats:p>","DOI":"10.1136\/bcr-2019-233498","type":"journal-article","created":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T03:15:52Z","timestamp":1604459752000},"page":"e233498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Melioidosis of the nervous system: atypical presentation of a rare disease in a 48-year-old man"],"prefix":"10.1136","volume":"13","author":[{"given":"Saif","family":"Hamdoon","sequence":"first","affiliation":[{"name":"Department of Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Queensland Health, Cairns, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Gericke","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Prince Charles Hospital, Chermside, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"2025082702591418000_13.11.e233498.1","doi-asserted-by":"crossref","unstructured":"Currie BJ . 223 - Burkholderia pseudomallei and Burkholderia mallei: Melioidosis and Glanders A2 - Bennett, John E. 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