trimethoprim--sulfamethoxazole-drug-combination and Neuroleptic-Malignant-Syndrome

Neurological melioidosis, an extremely rare condition, is caused by the gram-negative bacterium Burkholderia pseudomallei. If treatment is suboptimal or delayed, this infection can produce diverse clinical symptoms and result in death.. A healthy 65-year-old female who had been treated with antipsychotic medication for neurotic depression for over 2 years presented with acute-onset fever, headache, lead-pipe rigidity of all limbs, and delirium.. Melioidosis meningitis was diagnosed by performing blood examinations and cerebrospinal fluid analysis and cultures.. Intravenous ceftazidime (2 g/8 h for 3 weeks) was administered in-hospital and 240 mg trimethoprim/1200 mg sulfamethoxazole and 100 mg minocycline twice daily administered out-hospital.. The patient fully recovered after antibiotic therapy without cognitive deficits and associated neurological complications.. Because melioidosis is endemic in Southern Taiwan and the use of antipsychotics might mask the symptoms, physicians dealing with patients from endemic areas with a medical history of antipsychotics should always consider the possibility of neurological melioidosis and provide prompt empirical management to suspicious cases.

Topics: Aged; Anti-Bacterial Agents; Antipsychotic Agents; Burkholderia pseudomallei; Ceftazidime; Cerebrospinal Fluid; Depressive Disorder; Diagnosis, Differential; Female; Humans; Melioidosis; Meningitis, Bacterial; Minocycline; Neuroleptic Malignant Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination