Contiguous spread of melioidosis to the brain: a rare case of subdural empyema following odontogenic infection. Illustrative case

BACKGROUND: Melioidosis, caused by Burkholderia pseudomallei, is an opportunistic infection endemic to Southeast Asia. CNS involvement is rare, but is associated with significant morbidity and mortality. Subdural empyema arising from odontogenic melioidosis has been rarely reported. OBSERVATIONS: A 50-year-old male with newly diagnosed diabetes mellitus presented with progressive right facial swelling, fever, and dizziness 1 week following dental extraction. CT of the head and neck revealed a right masticator space abscess with extension into the parotid and extraconal orbital spaces. Blood cultures isolated B. pseudomallei. Despite intravenous meropenem, the infection progressed to a right temporal lobe abscess with adjacent subdural empyema, as well as subperiosteal and lateral rectus muscle abscesses. The patient underwent right-sided craniotomy with drainage of the subdural abscess and anterior temporal lobectomy. Intraoperative findings confirmed extensive granulation tissue and a localized subdural abscess near the precentral gyrus. Postoperatively, he experienced refractory seizures requiring multiple antiepileptic agents. Follow-up CT imaging of the brain showed interval resolution of abscesses and improving craniofacial inflammation. LESSONS: Although CNS involvement by B. pseudomallei is rare, early recognition and prompt intervention are crucial in achieving satisfactory infection control. https://thejns.org/doi/10.3171/CASE25519.