# Two Years, Many Clues: Diagnostic Journey and Treatment of Chronic Neurobrucellosis in an Elderly Woman

## TL;DR

A 61-year-old woman with chronic neurological symptoms was eventually diagnosed with neurobrucellosis after a two-year journey, highlighting the disease's diagnostic challenges.

## Contribution

The paper presents a rare case of chronic neurobrucellosis diagnosed after prolonged misdiagnosis and emphasizes the importance of considering this condition in unexplained neurological cases.

## Key findings

- Chronic neurobrucellosis was confirmed after isolating Brucella melitensis from cerebrospinal fluid.
- Neurological symptoms persisted for two years with initial misdiagnosis as CNS vasculitis.
- Targeted antibiotic treatment led to significant clinical improvement in the patient.

## Abstract

Neurobrucellosis is a rare complication of brucellosis, a zoonotic infection caused by Brucella spp. Its varied neurological manifestations make diagnosis difficult, often resulting in delays and increased morbidity. We present the case of a 61-year-old woman with recurrent neurological symptoms over two years, including confusion, gait imbalance, and cognitive decline. Despite extensive investigations showing ischemic changes on brain imaging, intrathecal IgG synthesis, and persistent cerebrospinal fluid (CSF) lymphocytic pleocytosis with initially sterile cultures, a presumptive diagnosis of primary central nervous system (CNS) vasculitis was made. After several hospital admissions and empirical treatments, Brucella melitensis was eventually isolated from the CSF, confirming chronic neurobrucellosis. Targeted antibiotic therapy led to significant clinical improvement. This case underscores the need to consider neurobrucellosis in patients with chronic or unexplained neurological symptoms, even when exposure history is unclear. Long incubation periods and nonspecific symptoms can make exposure difficult to recall and may cause clinicians to focus initially on more common etiologies.