A 23-year-old woman from a rural area with low-grade fever for 4 months, now with acute weakness in both lower limbs and inability to pass urine
What is your diagnosis?
The answer is Neurobrucellosis
Additional Clinical History: Had a pet cow; often drank unpasteurized milk
Background:
Neurobrucellosis is an endemic zoonotic infection caused by bacterial genus Brucella.
It is transmitted to humans by infected animals (sheep, cattle, goats, pigs, and dogs) urine, milk, and other fluids.
The endemic areas of brucellosis include the Mediterranean region, Latin America, western Asia, and parts of Africa, according to the CDC.
Clinical Presentation:
The symptoms of neurobrucellosis may include symptoms like headache, fever, or muscle or joint pain, along with neurologic symptoms such as confusion, meningoencephalitis, myelitis, peripheral and cranial neuropathies, and psychiatric manifestations.
Place of residence or dietary, travel, or occupational history suggests a risk for the infection.
Key Diagnostic Features:
Sign and symptoms of neurobrucellosis
Positive blood culture
Isolation of Brucella species from cerebrospinal fluid and/or presence of anti-Brucella antibodies in CSF
Presence of lymphocytosis, increased protein, and decreased glucose levels in the CSF
Findings on MRI or CT: MRI, hyperintense periventricular and white matter lesions on T2WI and FLAIR
Differential Diagnosis:
Demyelinating disorders
Viral encephalomyelitis
Granulomatous encephalomyelitis (ie,tuberculosis, fungal infection, and sarcoidosis)
Conclusion:
Neurobrucellosis is a treatable disease with a favorable outcome if diagnosed early.
It is extremely difficult to diagnose or suspect neurobrucellosis on the basis of radiologic appearance of encephalomyelitis, which is a rare presentation.
History of exposure should always be sought, as the disease may present with protean symptoms and radiologic manifestations.
Treatment Options:
Antimicrobial drugs like Rifampicin, doxycycline, ceftriaxone, or co-trimoxazole for a duration of 3–6 months or until normalization of CSF.
From AJNR CASE OF THE MONTH
中文版：
女性，23歲，來自農村，低熱4月，突發雙下肢無力，不能排尿。
診斷：神經布魯氏菌病
追問病史：患者有一頭奶牛，經常飲用未滅菌的牛奶
背景：
神經布魯氏菌病是一種動物傳染的地方性疾病，致病菌為布魯氏桿菌。
由被感染動物（綿羊，牛，山羊，豬，狗）的尿液、奶及其他分泌液傳播給人類。
CDC數據顯示，該病易發區域位於地中海地區、拉丁美洲、西亞以及部分非洲地區。
臨床表現：
頭痛、發熱、肌肉關節痛，同時合併神經系統症狀，如：意識模糊、腦膜腦炎、脊髓炎、周圍神經及顱神經病變以及精神異常。
在病區居住、飲食、旅遊或職業史為感染的危險因素。
診斷要點：
具有神經布魯氏桿菌感染的臨床表現。
血培養陽性。
腦脊液可分離出布魯氏桿菌，或/和檢測到抗布魯氏菌抗體。
腦脊液淋巴結細胞增多，蛋白增多，葡萄糖降低。
MRI表現：腦室旁及腦白質內T2WI和FLAIR高信號病灶。
鑑別診斷：
脫髓鞘病變
病毒性腦脊髓炎
肉芽腫性腦脊髓炎（如：結核、真菌感染以及結節病）
總結：
神經布魯氏菌病是一種可治療的疾病，如早期正確診斷，預後良好。
該病影像極少呈腦脊髓炎表現，此時，根據影像表現診斷該病非常困難。
該病臨床表現及影像表現千變萬化，所以應及時追問患者的病區暴露史。
治療：
抗菌藥物治療，如利福平、多西環素、頭孢曲松或複方新諾明，療程為3-6個月或直至腦脊液檢查正常。