Sofia Sobkiv1, Laura Vargas1, Matthew Roberts2
1Department of Neurology, Prisma Health, 2Department of Neurology, University of South Carolina School of Medicine
Objective:
To describe an interesting case of neurobrucellosis and its diagnostic odyssey in a 57-year-old patient.
Background:
Neurobrucellosis occurs in approximately 4–7% of brucellosis cases and remains notoriously difficult to diagnose. Clinical manifestations are often nonspecific, neuroimaging may be unrevealing, and both serum and cerebrospinal fluid (CSF) testing have variable sensitivity and specificity. We present a case illustrating the complexities of recognition and diagnosis.
Results:
A 57-year-old man with hypertension, diabetes, prior stroke, and no recent travel outside the USA presented with two weeks of progressive confusion characterized by impaired attention, visual hallucinations, and inability to recognize family members. He had also experienced a 50-pound weight loss over four months. Initial brain magnetic resonance imaging (MRI) was normal, and he was treated empirically for Wernicke’s encephalopathy without improvement. Subsequent lumbar puncture revealed lymphocytic pleocytosis, low glucose, and elevated protein. A repeat MRI three weeks later demonstrated basilar leptomeningeal enhancement concerning for meningitis, though bacterial and fungal cultures and a meningitis PCR panel were negative. Given persistent suspicion for infection, Karius plasma microbial cell-free DNA testing was pursued and identified Brucella, confirming neurobrucellosis. He was started on targeted antibiotic therapy with 6 weeks of ceftriaxone and 12 weeks of rifampin plus doxycycline per infectious disease recommendations. During hospitalization, he developed an ischemic stroke, attributed to meningitic vasculitis, requiring corticosteroids. Following completion of antibiotics and steroids, he had complete symptom resolution and was able to return to work.
Conclusions:
Neurobrucellosis is a rare but treatable infection whose diagnosis requires a high index of suspicion, careful history-taking, and thorough neurological examination. This case underscores the importance of considering uncommon etiologies when standard studies are inconclusive, the utility of advanced molecular diagnostics, and the value of multidisciplinary collaboration. Vigilant monitoring is essential for recognizing complications such as meningitic vasculitis, which may influence both treatment and prognosis.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.