Paraplegia secondary to Burkholderia pseudomallei myelitis: A case report

Bacterial infection is an uncommon cause of acute paraplegia. A 42-year-old Aboriginal man presented to a remote health clinic in northern Australia w ith myelitis associated with Burk-holderia pseudomallei. He was treated wit h analgesia and intravenous flucloxacillin, ceftriaxone, and gentamicin and transferred to our hospital, where an urgent T12-L1 laminectomy and decomp ression was performed. Urine culture confirmed B. pseudomallei infection (m elioidosis). Abdominopelvic computed tomography revealed left prostatic lob e 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 tra nsverse myelitis. His rehabilitation was complicated by his difficulty in a djusting to disability, by urinary retention and fecal incontinence, by com munication barriers, and his isolation from a culture familiar to him. He r eturned to his community after 15 weeks, free of infection, with T10-11 par aplegia and an indwelling catheter.