Unusual presentation of neurobrucellosis presenting with the features of parkinsonism: two case reports and a review of the literature.

BACKGROUND

Brucellosis, a zoonotic disease caused by species, remains endemic in regions such as Saudi Arabia. While neurobrucellosis is a serious complication, its presentation with parkinsonian features and psychiatric manifestations is exceedingly rare, with only five such cases reported in the literature. These case reports add to the limited data on atypical presentations of neurobrucellosis.

OBJECTIVE

To describe two cases of neurobrucellosis presenting with Parkinsonism-like symptoms and psychiatric manifestations, highlighting the diagnostic challenges and therapeutic responses in a rare manifestation of this zoonotic infection.

DESIGN/METHODS: We report two male patients from Saudi Arabia, aged 75 and 26, diagnosed with neurobrucellosis based on high titers and cerebrospinal fluid polymerase chain reaction (CSF PCR) results. Both patients presented with Parkinsonism-like symptoms, including tremors, rigidity, and bradykinesia, alongside significant psychiatric disturbances such as hallucinations and cognitive impairment. Brain magnetic resonance imaging (MRI) in both cases revealed abnormalities consistent with meningoencephalitis. Both patients received a combination of antibiotics (doxycycline, rifampicin, and sulfamethoxazole-trimethoprim) and corticosteroids to manage inflammation.

RESULTS

Prolonged antibiotic therapy led to significant clinical improvement in both patients, with marked reduction in both neurological and psychiatric symptoms. Despite improvement, residual Parkinsonism-like symptoms persisted, necessitating extended therapy and long-term follow-up.

CONCLUSION

These cases emphasize the importance of considering neurobrucellosis in patients from endemic regions with atypical neurological and psychiatric symptoms. Early diagnosis through serological and molecular testing, followed by prompt and prolonged antibiotic therapy, is crucial for favorable outcomes.