Abstract

Introduction: Neurobrucellosis is a rare and severe complication of brucellosis, with varied and often nonspecific neuroimaging findings, making diagnosis challenging. Neuroborreliosis, caused by Brucella bacteria, is a challenging diagnosis due to its varied neurological manifestations, which often mimic other infections like tuberculosis. The primary infection route is consuming unpasteurized dairy products. It can present as chronic meningitis, intracranial hypertension, or meningoencephalitis. Diagnosis requires a high degree of suspicion, especially in cases of chronic meningitis, to prevent delays and complications. This report reviews its clinical features, diagnosis, treatment, and prognosis.

Methods: Descriptive case report.

Case details: A paediatric patient presented with acute symptoms of altered sensorium, high-grade fever lasting two days, and intermittent abnormal posturing for one day. Initial clinical suspicion strongly favored an infective etiology. MRI revealed atypical findings, including nodular lesions in the cerebrum and cerebellum exhibiting diffusion restriction, along with diffuse cerebral edema. Serological testing returned a positive Brucella IgM result. The child was successfully treated with a 45-day triple antibiotic regimen consisting of Rifampicin, Co-trimoxazole, and Ceftriaxone, supplemented with pulse methylprednisolone followed by a tapering course of corticosteroids to address neuroinflammation. Concurrent nutritional deficiencies were also managed during treatment.

Conclusion: This case highlights the importance of considering neurobrucellosis in endemic areas, even with atypical imaging presentation. A combination of serological tests and neuroimaging is crucial for diagnosis. Timely initiation of combined antibiotic and anti-inflammatory therapy can lead to an excellent clinical outcome.

Keywords:Neurobrucellosis; Encephalitis; Atypical neuroimaging; Corticosteroids; Triple regimen; Hyperhomocystenemia