title: Central Nervous System Melioidosis Mimics Malignancy: A Case Report and Literature Review.
abstract: BACKGROUND
  Central nervous system (CNS) melioidosis is notorious because of the difficulty in bacteria eradication and the destruction of brain structures. Early manifestation of CNS melioidosis mimics malignancy or stroke. We present a case of CNS melioidosis that initially manifested as malignancy.
  
  
  METHODS
  A 30-year-old man presented with sudden onset of left limb weakness and seizure. Computed tomography of the brain showed a low-density lesion over the right parietal lobe, and magnetic resonance imaging showed a well-enhanced lobulated lesion. Neuronavigation-guided open surgery was performed but failed to find a malignancy. The patient presented 3 days later with sudden loss of consciousness, pupil dilation, and high fever. Emergent craniectomy was performed for severe right hemisphere swelling with midline shift. After craniectomy, pus was found in the previous operative field. Burkholderia pseudomallei was cultured from pus and blood samples 1 week after collection. The brain lesion developed into an organized abscess and led to mass effect and ventriculitis. Extraventricular drainage and débridement was performed repeatedly accompanied by systemic and intraventricular antibiotic administration. After 4 months of treatment, the patient achieved a complete consciousness recover while left hemiparesis.
  
  
  CONCLUSIONS
  CNS melioidosis requires accurate pathogen identification and appropriate long-term antibiotic treatment for eradication of bacteria and prevention of relapse. Débridement and adequate drainage provide better infection control and outcome.
authors.affiliation: Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung City, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung City, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. Electronic address: sychen0102@gmail.com.
authors.forename: Se-Yi
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Central Texas Veterans Health Care System, Austin, Texas.
authors.forename: Ting-Yi
authors.initials: TY
authors.lastname: Chen
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Szu-Ting
authors.initials: ST
authors.lastname: Chen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D020806:Central Nervous System Bacterial Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016543:Central Nervous System Neoplasms / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008554:Melioidosis / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Brain abscess; Burkholderia pseudomallei; CNS melioidosis; Intraventricular antibiotics; MRS