Melioidosis Presenting as Orbital Cellulitis and Brainstem Infarction

REPORTsyndrome and right orbital cellulitis.Intravenous (IV) meropenem was initiated. POD 1The patient underwent functional endoscopic sinus surgery (FESS) with samples sent for microbiology and histopathology.Empirical amphotericin-B was started for suspected fungal sinusitis.Laboratories showed leukocytosis [total leukocyte count (TLC): 7.1 10 3 /L] and elevated C-reactive protein (CRP 32 mg/L).He remained afebrile in intensive care unit (ICU). IntroductIonMelioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei, is endemic in Southeast Asia and northern Australia but increasingly identified worldwide, particularly in immunocompromised individuals. [1][2]2][3][4] Diabetes mellitus markedly increases both susceptibility and severity. [5][6]6][7] While pulmonary and visceral involvement are typical, orbital presentations are rare but can rapidly progress to cavernous sinus thrombosis, meningitis, or brainstem infarction. 2,8,9 Diagnosis remains challenging when routine blood or cerebrospinal fluid (CSF) cultures are negative, necessitating early tissue sampling. 1,10This report describes a fulminant case of orbital cellulitis with pansinusitis complicated by meningitis and brainstem infarction in an uncontrolled diabetic, emphasizing diagnostic and therapeutic complexities. case descrIptIon Day 1: Admission, Postoperative Day (POD 0)A 43-year-old farmer with poorly controlled type 2 diabetes [glycated hemoglobin (HbA1c) 11.7%] presented with 10 days of right eye pain, swelling, redness, and intermittent fever.Examination showed proptosis, ptosis, restricted extraocular movements, sluggish right pupil response, and mildly reduced visual acuity; neurological findings were initially normal.Computed tomography (CT)/magnetic resonance imaging (MRI) revealed pansinusitis with orbital apex