Double trouble: The intersection of neurobrucellosis and systemic lupus erythematosus in a 24-year-old female

Abstract

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple organs, while brucellosis is a zoonotic infection prevalent in endemic areas. Neurobrucellosis, a severe complication of brucellosis, can mimic or coexist with autoimmune conditions like SLE, complicating diagnosis and treatment. This case report highlights the diagnostic challenges and management strategies for such overlapping diseases.

Case presentation

In this case report, we present a 24-year-old female who initially presented with symptoms that were misleadingly attributed to a simple vaginal ulcer. Her clinical course evolved to include migratory polyarthralgia, nocturnal fevers, and significant weight loss, eventually culminating in severe headaches and dizziness that led to a diagnosis of meningitis. Comprehensive diagnostic work-up, including the presence of a malar rash, positive anti-dsDNA antibodies, and elevated inflammatory markers, pointed towards SLE. However, the identification of bacterial infection markers in the cerebrospinal fluid (CSF) and her history of animal contact in an endemic area led to the diagnosis of neurobrucellosis. The patient's remarkable response to doxycycline and rifampicin confirmed the infectious etiology, highlighting the complex interplay between these two diseases.

Conclusion

The intersection of SLE and neurobrucellosis in this patient underscores the importance of a multidisciplinary approach to diagnosis and treatment, ensuring that both the autoimmune and infectious aspects of the patient's condition are adequately addressed. This case contributes valuable insights into the management of such rare and complex presentations, emphasizing the need for vigilance and adaptability in clinical practice.