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

## TL;DR

An elderly butcher in Iran developed severe neurological symptoms, later diagnosed as neurobrucellosis, highlighting the need for awareness of this condition in endemic regions.

## Contribution

This case report highlights the rare and atypical neurological presentation of neurobrucellosis and emphasizes its diagnostic challenges.

## Key findings

- Neurobrucellosis can present with global aphasia and paraplegia, mimicking other neurological disorders.
- Combination antibiotic therapy led to significant improvement in symptoms and declining serological titers over two years.
- The case underscores the importance of considering neurobrucellosis in unexplained neurological presentations in endemic regions.

## Abstract

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

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.

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.

•Neurobrucellosis mimics a wide spectrum from Guillain-Barré-like syndrome to acute cerebrovascular event due to vasculitis.•Neurobrucellosis merits consideration as differential diagnosis of unexplained neurological manifestations in endemic regions.•Comprehensive evaluation and awareness of atypical patterns are crucial to avoid misdiagnosis.

Neurobrucellosis mimics a wide spectrum from Guillain-Barré-like syndrome to acute cerebrovascular event due to vasculitis.

Neurobrucellosis merits consideration as differential diagnosis of unexplained neurological manifestations in endemic regions.

Comprehensive evaluation and awareness of atypical patterns are crucial to avoid misdiagnosis.