Asian Journal of Research and Reports in Neurology

Neuromelioidosis is an uncommon manifestation of melioidosis that may resemble acute stroke when focal neurological deficits predominate. Recurrent symptoms following treatment can complicate diagnosis, particularly when microbiological evidence from the central nervous system is unavailable. We report the case of a 38-year-old man with diabetes mellitus and systemic hypertension who developed acute weakness of the left upper and lower limbs, slurred speech and rightward facial deviation, accompanied by fever. Two months earlier, he had received antimicrobial treatment for a febrile respiratory illness associated with joint pain and ulcerative lesions. Examination revealed left upper motor neurone facial weakness, with grade 3 power in the left upper limb and grade 4 power in the left lower limb. Brain computed tomography demonstrated a right frontoparietal abnormality, while magnetic resonance imaging showed white-matter FLAIR hyperintensity, central diffusion restriction, susceptibility blooming and post-contrast meningeal enhancement, consistent with suspected focal cerebritis without a formed abscess. Blood culture yielded Burkholderia pseudomallei, with reported susceptibility to ceftazidime, meropenem and trimethoprim–sulfamethoxazole. The patient received intravenous meropenem for eight weeks, followed by oral Septran for one year, and achieved complete clinical recovery. The temporal pattern was compatible with recurrent melioidosis, but relapse could not be distinguished definitively from reinfection without paired-isolate molecular analysis. This case highlights the value of integrating systemic symptoms, neuroimaging and blood culture findings when assessing stroke-like presentations.