MRI findings in a child with Neuromelioidosis

A 10-year-old boy presented with a 2-week history of fever, headache, and altered mentation. Bulbar palsy, 2/5 right hemiparesis, and meningeal signs were evident. CSF was notable for lymphocytosis, high protein, normal glucose, and negative tuberculosis workup. MRI demonstrated hyperintensity along the white matter tracts suggestive of neuromelioidosis (figure) and was confirmed by antibody positivity to indirect hemagglutination for Burkholderia pseudomallei. The child responded to 6 weeks of induction therapy with meropenem and is currently on eradication treatment with doxycycline. Propensity for spread along the white matter tract and brainstem neurotropism is the hallmark of neuromelioidosis, especially the encephalomyelitis type.1