Brachial and Lumbosacral Plexitis in Neuromelioidosis: Clinical and Magnetic Resonance Neurography Features from an Endemic Region in Southern India

Melioidosis, which is caused by Burkholderia pseudomallei, involves the nervous system in up to 10% of cases and carries high mortality. Although cranial nerve involvement is described in neuromelioidosis, spinal nerve involvement and possible central nervous system spread through spinal nerves are rarely reported. After an index case with brachial plexus involvement, we screened all patients with neuromelioidosis admitted to our institute between November 2024 and April 2025 for spinal nerve and/or plexus involvement. Among 11 patients with neuromelioidosis, 4 had peripheral nerve and/or plexus involvement. Three patients also had concomitant encephalomyelitis. Glycemic status and exposure to immunosuppressive therapy appeared to influence the clinical phenotype. Although Guillain-Barre syndrome-like presentations have been described in neuromelioidosis, our patients had features atypical of Guillain-Barre syndrome. We describe the clinical and neuroimaging features of these four patients. Recognition that concurrent central and spinal peripheral nervous system involvement can occur in neuromelioidosis has diagnostic and therapeutic implications.