Neurobrucellosis presenting with the features of meningoencephalitis: A case report from Nepal.

INTRODUCTION AND IMPORTANCE

Brucellosis or Malta fever is a zoonotic disease caused by the Brucella species. Patients with neurobrucellosis may present with features of meningoencephalitis. Thus, a high degree of suspicion is required for the diagnosis in the endemic region.

CASE PRESENTATION

A 13-year old female with a history of exposure to domestic animals presented with the features of meningoencephalitis (intermittent fever with chills and rigor and generalized tonic-clonic seizure).

CLINICAL FINDINGS AND INVESTIGATIONS

Examination revealed drowsy and lethargic patient with bilateral edema up to mid-shin. Neck rigidity was present. Lab findings include leukocytosis with neutrophilic and erythrocyte sedimentation rate (25 mm/hr). CECT of the brain revealed vasogenic edema. Routine CSF examination was insignificant for common bacterial, viral, fungal or tubercular etiology. CSF ELISA confirmed the presence of Brucella antibody.

CONCLUSION

When patients present with undulant fever, lethargy, seizure, or other features of meningitis/encephalitis, the diagnosis of neurobrucellosis must be considered after common pathological causes are ruled out.