Focal Pachymeningitis in a Returning Traveler with Melioidosis

The dura mater thickens as a result of the uncommon diffuse inflammatory condition known as hypertrophic pachymeningitis. Burkholderia pseudomallei, a Gram-negative bacillus, is the primary cause of the endemic illness melioidosis in South-East Asia and Northern Australia. There are many different manifestations, and neurological involvement has rarely been discussed. In this paper, we report a patient returning from Asia with an unusual infection including CNS involvement consistent with a melioidosis. This diagnosis was challenging and complex to carry out with multiple considerations, mainly because of the atypical nature of the germ. Burkholderia pseudomallei can be easily misidentified with Burkholderia thailandensis (rarely pathogenic to humans) during bacterial culture because of their phylogenetic proximity. The main pitfall of the management was that the responsible infectious agent was not referenced in the MALDI-TOF (considered as a bioterrorism agent) and led to a wrong strategy. This melioidosis case illustrates the challenge in melioidosis diagnosis in a patient returning from an endemic area and the disease's frequent involvement of several organs. An new, possibly lethal condition called melioidosis need for protracted antibiotic therapy. Melioidosis identification challenges in clinical microbiology laboratories, particularly in non-endemic regions with low clinical suspicion, may delay treatment and have an impact on the course of the disease.