title: Paraplegia secondary to Burkholderia pseudomallei myelitis: a case report.
abstract: Bacterial infection is an uncommon cause of acute paraplegia. A 42-year-old Aboriginal man presented to a remote health clinic in northern Australia with myelitis associated with Burkholderia pseudomallei. He was treated with analgesia and intravenous flucloxacillin, ceftriaxone, and gentamicin and transferred to our hospital, where an urgent T12-L1 laminectomy and decompression was performed. Urine culture confirmed B. pseudomallei infection (melioidosis). Abdominopelvic computed tomography revealed left prostatic lobe and right periprostatic abscesses, which were managed conservatively. The patient was given intravenous ceftazidime (8g/d) for 2 months, followed by oral sulfamethoxazole (1600mg) and trimethoprim (320mg) twice daily for 8 weeks. Magnetic resonance imaging 3 weeks after his admission confirmed transverse myelitis. His rehabilitation was complicated by his difficulty in adjusting to disability, by urinary retention and fecal incontinence, by communication barriers, and his isolation from a culture familiar to him. He returned to his community after 15 weeks, free of infection, with T10-11 paraplegia and an indwelling catheter.
authors.affiliation: Department of Rehabilitation Medicine, Royal Darwin Hospital and Northern Territory Clinical School, Flinders University, Casuarina, Northern Territory, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Haran
authors.forename: A W
authors.initials: AW
authors.lastname: Jenney
authors.forename: R J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: H D
authors.initials: HD
authors.lastname: Flavell
authors.forename: N M
authors.initials: NM
authors.lastname: Anstey
authors.forename: B J
authors.initials: BJ
authors.lastname: Currie
mesh_terms: D000328:Adult; D016957:Burkholderia pseudomallei; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000382:microbiology* / Q000534:rehabilitation; D009187:Myelitis / Q000382:microbiology* / Q000534:rehabilitation; D010264:Paraplegia / Q000382:microbiology* / Q000534:rehabilitation