Neurobrucellosis; A case report

Background: Brucellosis with different pictures is common in our country and should be noticed in high risk patients. Patient: A 23 years old male farmer, presented with headache, vomiting, and tremor. Disease had begun 6 months ago with right side orchitis, fever, chills, then, gradually illness, weakness, tremor, anorexia, vomiting, nonproductive cough,retrosternal pain and dysphagia, blurred vision, generalized muscular rigidity and disability in daily activities were added. In physical exam illness, weakness, fever, wet skin, tremor, generalized muscular rigidity, papillary edema were detected. He had positive Wright test (1/1250) and lymphocytic pleocytosis in CSF. Three drug regimen and steroid (1 month) were administered and he responded well to this initial therapy, however, during his 3rd month follow up, he developed severe bilateral hearing loss unresponsive to steroids and 6 months later he had a self-limiting 20 hours left sided hemiparesis. Conclusion: Neurobrucellosis may present with parkinsonism (tremor and generalized muscular rigidity) and meningovascular involvement. This may even progress under 3 antibiotic regimen treatment