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A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon

Burkholderia pseudomallei, the agent of melioidosis, can cause multisystemic infections, including rare cases in the central nervous system (CNS). Isolated CNS melioidosis is particularly rare, with a 3% of cases in long-term study. In this region that is high endemicity, risk factors include direct...

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Main Authors: Mohamed, Nurdiyana, Yahya, Muhammad Zakwan, Abdul Samat, Muttaqillah Najihan, Abdul Hamid, Hamzaini
Format: Article
Language:English
Published: RSIS International 2024
Subjects:
RJ Pediatrics
Online Access:http://irep.iium.edu.my/117643/7/117643_ARareCaseofIsolatedPaediatricCentralNervousSystem.pdf
http://irep.iium.edu.my/117643/
https://rsisinternational.org/journals/ijrsi/articles/a-rare-case-of-isolated-paediatric-central-nervous-system-melioidosis-an-imaging-chameleon/
https://doi.org/10.51244/IJRSI.2024.11120005
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spelling my.iium.irep.1176432025-01-07T04:40:20Z http://irep.iium.edu.my/117643/ A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon Mohamed, Nurdiyana Yahya, Muhammad Zakwan Abdul Samat, Muttaqillah Najihan Abdul Hamid, Hamzaini RJ Pediatrics Burkholderia pseudomallei, the agent of melioidosis, can cause multisystemic infections, including rare cases in the central nervous system (CNS). Isolated CNS melioidosis is particularly rare, with a 3% of cases in long-term study. In this region that is high endemicity, risk factors include direct contact with contaminated soil or water, particularly among individual with immunosuppressive condition. Without timely intervention, CNS melioidosis will lead to high mortality and morbidity rate. Case Presentation: A 6-year-old boy with G6PD deficiency and acute lymphoblastic leukaemia (B cell ALL) presented with a persistent headache and intermittent fever for two months and vomiting for one day. CNS examination was unremarkable. CT and MRI revealed a right fronto-parietal rim-enhancing lesion with mass effect, suggesting meningeal tuberculoma, infection, or malignancy. Abdominal ultrasound and chest x-ray were negative for abscesses. Craniotomy and tumour excision were performed, and culture confirmed Burkholderia pseudomallei. Conclusion: Imaging is essential for differentiating CNS melioidosis from malignancy and characterizing the infection. Diffusion-weighted imaging (DWI) on MRI can help distinguish pyogenic abscesses from cystic tumours. The involvement of white matter tracts and brainstem in CNS melioidosis aids differentiation from other infections, like tuberculosis. In endemic regions, CNS melioidosis should be considered in patients with relevant risk factors, clinical suspicion, and radiological evidence. Microbiological diagnosis is vital for early targeted therapy and improved recovery. RSIS International 2024-12-28 Article PeerReviewed application/pdf en http://irep.iium.edu.my/117643/7/117643_ARareCaseofIsolatedPaediatricCentralNervousSystem.pdf Mohamed, Nurdiyana and Yahya, Muhammad Zakwan and Abdul Samat, Muttaqillah Najihan and Abdul Hamid, Hamzaini (2024) A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon. International Journal Of Research And Scientific Innovation (IJRSI), 11 (12). pp. 49-54. ISSN 2321-2705 https://rsisinternational.org/journals/ijrsi/articles/a-rare-case-of-isolated-paediatric-central-nervous-system-melioidosis-an-imaging-chameleon/ https://doi.org/10.51244/IJRSI.2024.11120005
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RJ Pediatrics
spellingShingle RJ Pediatrics
Mohamed, Nurdiyana
Yahya, Muhammad Zakwan
Abdul Samat, Muttaqillah Najihan
Abdul Hamid, Hamzaini
A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
description Burkholderia pseudomallei, the agent of melioidosis, can cause multisystemic infections, including rare cases in the central nervous system (CNS). Isolated CNS melioidosis is particularly rare, with a 3% of cases in long-term study. In this region that is high endemicity, risk factors include direct contact with contaminated soil or water, particularly among individual with immunosuppressive condition. Without timely intervention, CNS melioidosis will lead to high mortality and morbidity rate. Case Presentation: A 6-year-old boy with G6PD deficiency and acute lymphoblastic leukaemia (B cell ALL) presented with a persistent headache and intermittent fever for two months and vomiting for one day. CNS examination was unremarkable. CT and MRI revealed a right fronto-parietal rim-enhancing lesion with mass effect, suggesting meningeal tuberculoma, infection, or malignancy. Abdominal ultrasound and chest x-ray were negative for abscesses. Craniotomy and tumour excision were performed, and culture confirmed Burkholderia pseudomallei. Conclusion: Imaging is essential for differentiating CNS melioidosis from malignancy and characterizing the infection. Diffusion-weighted imaging (DWI) on MRI can help distinguish pyogenic abscesses from cystic tumours. The involvement of white matter tracts and brainstem in CNS melioidosis aids differentiation from other infections, like tuberculosis. In endemic regions, CNS melioidosis should be considered in patients with relevant risk factors, clinical suspicion, and radiological evidence. Microbiological diagnosis is vital for early targeted therapy and improved recovery.
format Article
author Mohamed, Nurdiyana
Yahya, Muhammad Zakwan
Abdul Samat, Muttaqillah Najihan
Abdul Hamid, Hamzaini
author_facet Mohamed, Nurdiyana
Yahya, Muhammad Zakwan
Abdul Samat, Muttaqillah Najihan
Abdul Hamid, Hamzaini
author_sort Mohamed, Nurdiyana
title A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
title_short A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
title_full A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
title_fullStr A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
title_full_unstemmed A rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
title_sort rare case of isolated paediatric central nervous system melioidosis: an imaging chameleon
publisher RSIS International
publishDate 2024
url http://irep.iium.edu.my/117643/7/117643_ARareCaseofIsolatedPaediatricCentralNervousSystem.pdf
http://irep.iium.edu.my/117643/
https://rsisinternational.org/journals/ijrsi/articles/a-rare-case-of-isolated-paediatric-central-nervous-system-melioidosis-an-imaging-chameleon/
https://doi.org/10.51244/IJRSI.2024.11120005
_version_ 1821105159379353600
score 13.239859

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