Neurobrucellosis presenting with concurrent paraplegia and global aphasia in an elderly butcher: A case report and literature review

Abstract

Background

Brucellosis is a prevalent zoonotic infection and presents with wide range of clinical manifestations, including rare but severe neurological complications.

Case presentation

We report the case of a 68-year-old male butcher presenting with global aphasia, paraplegia, incontinence, excessive sweating two weeks prior to admission, and significant weight loss over eight months. Initial evaluations, including brain CT, lumbar puncture, and neurological studies were inconclusive. Spinal MRI showed L1-L2 spondylodiscitis. Serological tests, cerebrospinal fluid culture, and positive Brucella melitensis PCR supported a neurobrucellosis diagnosis. Treatment with a combination of gentamicin, ceftriaxone, rifampicin, and doxycycline was initiated, followed by outpatient therapy with rifampicin, doxycycline, and sulfamethoxazole-trimethoprim for three months. Significant symptom improvement and declining serological titers were observed over two years of follow-up.

Conclusion

This case underscores the diagnostic challenges of neurobrucellosis due to its nonspecific presentation and emphasize on the importance of considering such etiologies in patients with unexplained neurological symptoms, particularly in endemic regions like Iran.