Jabbour Rosette A, Tabbarah Zuhayr
Faculty of Clinical Medicine, University of Balamand & Department of Neurology, St George Hospital University Medical Center, Beirut, Lebanon.
J Med Liban. 2011 Apr-Jun;59(2):105-8.
To report an unusual case of neurobrucellosis.
A 48-year-old man was admitted to Rafik Hariri University Hospital (RHUH) for progressive gait disturbances, hearing loss, and some episodes of chills without documented fever. The neurological examination showed gait ataxia, tremor in the legs and mild cognitive decline. The physical exam was otherwise normal.
Magnetic resonance imaging (MRI) of brain showed diffuse, bilateral, confluent, subcortical, and periventricular white matter disease. Serum agglutination test (SAT) for Brucella was positive in blood and cerebrospinal fluid (CSF). The patient was treated with a combination of ceftriaxone for one month, and doxycycline and rifampicin for one year and his condition stabilized. Literature review was performed. The possible underlying pathophysiological mechanisms are discussed.
Neurobrucellosis is a very rare complication of human brucellosis, and can present with a variety of central nervous system symptomatology (CNS) and MRI changes suggestive of leukoencephalopathy. Its diagnosis could be challenging and should always be suspected in patients presenting with CNS manifestations and/or diffuse white matter disease visualized on brain MRI, especially in Brucella endemic areas.
报告一例罕见的神经型布鲁氏菌病病例。
一名48岁男性因进行性步态障碍、听力丧失以及多次寒战发作（无发热记录）入住拉菲克·哈里里大学医院（RHUH）。神经系统检查显示步态共济失调、腿部震颤和轻度认知功能减退。体格检查其他方面正常。
脑部磁共振成像（MRI）显示弥漫性、双侧、融合性、皮质下和脑室周围白质病变。血液和脑脊液（CSF）的布鲁氏菌血清凝集试验（SAT）呈阳性。患者接受了头孢曲松治疗一个月，以及多西环素和利福平治疗一年，病情得以稳定。进行了文献综述，并讨论了可能的潜在病理生理机制。
神经型布鲁氏菌病是人类布鲁氏菌病非常罕见的并发症，可表现为多种中枢神经系统症状（CNS）以及提示白质脑病的MRI改变。其诊断可能具有挑战性，对于出现CNS表现和/或脑部MRI显示弥漫性白质病变的患者，尤其是在布鲁氏菌病流行地区，应始终怀疑该病。
