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An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism

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We report the first case of acute parkinsonism following disseminated melioidosis with multiorgan abscesses in a 62-year-old man. After 1 month of treatment with levodopa, the parkinsonism resolved completely. Melioidosis should be considered as a possible cause for parkinsonism in endemic areas.

A 62-year-old man presented to our tertiary hospital’s emergency department with a 4-week history of fever associated with lethargy and constitutional symptoms. For 9 days before admission, he had been vomiting two to three times per day. He had longstanding diabetes and hypertension and worked for the local city council as a truck driver, transporting water to local gardens and public areas. About 2 months previously, he had sustained an abrasion on his left foot that had healed completely at time of presentation.

On initial assessment, he had a blood pressure of 129/78 mmHg, a heart rate of 111 beats/min, an SpO2 of 96% in room air, and a respiratory rate of 16 breaths/min. He was clinically dehydrated and his body temperature was 38.8°C. His abdomen was soft and non-tender, with hepatomegaly of two fingers’ breadth. Respiratory examination revealed left basal lung crepitations. Results of the clinical assessment, including cardiovascular and neurological examinations, were otherwise normal.

The patient’s initial blood investigations revealed an elevated random blood glucose level…