Objective:

We report a case of a 44-year-old female with a history of diabetes mellitus (DM) and hypertension (HTN) who presented with fever, progressive bilateral lower limb weakness and numbness as well as urinary retention for 6 days. Neurological examination was remarkable for bilateral lower extremity weakness, diffuse hyperreflexia and sensory level above the umbilicus. Brain and spine MRI showed extensive T2/STIR hyperintensity extending from C2 to T11.
Further evaluations including serological testing and cerebrospinal fluid analysis showed mild leukocytosis with predominant neutrophils and elevated CSF protein. Viral PCR, bacterial culture and demyelinating disease work up were all negative. A positive brucella titer (1/320) confirmed Brucella myelitis. Patient was started on antibiotics and had a total of 5 sessions of plasma exchange (PLEX). Fever subsided during the course of admission, but the patient experienced significant residual neurological deficits, including spasticity, sensory impairment and urinary dysfunction. A follow up spine MRI was done 3 months later and showed spinal cord atrophy with no evidence of inflammation.
This case emphasizes the importance of considering neurobrucellosis in differential diagnosis of LETM, especially in regions where brucellosis is endemic. Further research is needed to better understand the pathogenesis and to identify optimal treatment strategies for Brucella myelitis. This report gives a share in existing literature on neurobrucellosis and focus on the importance of early diagnosis and appropriate management in patients with risk factors, such as unpasteurized dairy consumption or livestock exposure.

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