Clinical analysis of 5 cases of atypical neurobrucellosis / 中华地方病学杂志

ABSTRACT

Objective:To investigate the clinical characteristics of atypical neurobrucellosis.Methods:Retrospective analysis was made on the epidemiological characteristics, clinical manifestations, laboratory and imaging findings of five cases of atypical neurobrucellosis admitted to the People's Hospital of Inner Mongolia Autonomous Region from December 2020 to June 2021.Results:The age of the five cases ranged from four to sixty-nine years old, including three females and two males. Four cases had a clear history of sheep contact. Serum F1 antibody against brucellosis was positive in all five cases, serum tube agglutination test (SAT) was positive in three cases, lumbar puncture cerebrospinal fluid (CSF) examination showed increased intracranial pressure in four cases, and bacterial smear and tuberculosis culture were negative in all of the five cases. After magnetic resonance imaging (MRI), two cases were found to have abnormal intracranial high signals, of which one case was abnormal in bilateral frontal parietal lobe and right temporal occipital lobe, showing long T1 and T2 signals and increased fluid-attenuated inversion recovery sequence(FLAIR) signal; and another case was abnormal in bilateral corona radiata, posterior limbs of internal capsule and bilateral cerebral peduncles, it showed continuous T2 and FLAIR slightly high signal intensity. One case had abnormal signal in the spinal cord, showing a small patch like long T2 signal on the right side of the spinal cord at the level of C2-3 discs. Electromyography was abnormal in one case. Among the five cases, two cases presented with brucellosis encephalitis, one case with brucellosis myelitis, one case with glossopharyngeal nerve damage caused by brucellosis, and one case with brucellosis cerebrospinal neuropathy. All five patients were treated with a combination of doxycycline, rifampicin and ceftriaxone, and three patients had a good prognosis.Conclusions:The clinical manifestations of atypical neurobrucellosis are various. Clinicians should strengthen their understanding of the disease and reduce the chance of missed diagnosis and misdiagnosis.