Neuromelioidosis in Rajasthan: A rare and fatal manifestation of Burkholderia pseudomallei infection.

Background: Melioidosis, an often-fatal infection caused by Burkholderia pseudomallei, is typically endemic to wet, tropical regions. However, its occurrence in dry, arid zones like northwest India is underrecognized. Neuromelioidosis, the rare neurological form of this disease, presents with high morbidity and mortality. This report details a confirmed case of neuromelioidosis diagnosed in Rajasthan, India. Case Presentation: A 65-year-old male with a background of chronic obstructive pulmonary disease (COPD) presented with prolonged fever, respiratory symptoms, and altered mental status. Neurological examination revealed increased limb tone and extensor plantar responses. Imaging revealed subcortical white matter hypodensity and multiple centrilobular nodules. Initial cerebrospinal fluid (CSF) analysis was suggestive of tubercular meningitis; however, subsequent blood and CSF cultures confirmed Burkholderia pseudomallei. Despite initiation of intravenous meropenem and co-trimoxazole, the patient succumbed to multi-organ failure after 14 days. Discussion: Neuromelioidosis remains a diagnostic challenge due to its ability to mimic other CNS infections, particularly tuberculosis. This case underscores the critical role of microbiological confirmation in guiding treatment. While the standard treatment protocol includes an intensive phase with meropenem followed by maintenance with trimethoprim-sulfamethoxazole, delays in diagnosis significantly worsen outcomes. Conclusion: Clinicians should maintain a high index of suspicion for neuromelioidosis in patients with unexplained neurological symptoms, even in non-endemic, arid regions like Rajasthan. Timely diagnosis and targeted therapy are key to improving prognosis. This case highlights the need for greater awareness and diagnostic vigilance in atypical geographic settings.