Case Report
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Surprising Result in A Patient Presenting with Agitation: Neurobrucellosis

Year 2024, Volume: 6 Issue: 3, 131 - 133, 01.11.2024
https://doi.org/10.38175/phnx.1478894

Abstract

Brucellosis is one of the most common zoonotic diseases worldwide. Neurobrucellosis develops within approximately 12 months after the diagnosis of brucellosis. Since the classical triad of meningitis (fever, nuchal rigidity, confusion) is rare in cases of meningitis due to brucellosis, brucellosis should be considered in the differential diagnosis of patients with unexplained neurological findings in endemic areas. In our case, a 31-year-old male patient with no history of chronic disease in his medical history was admitted to the emergency department with agitation, confusion, meaningless movements, unsteadiness in walking and blurred vision which started on the same day. In his anamnesis, it was learned that he had been treated for brucella 8 months ago in an external centre, but he did not continue his treatment regularly and did not attend the follow-up visits. LP revealed microprotein 255 mg/dL and albumin 114 mg/dL. CSF brucella agglutination was positive at a titre of 1/40. The patient was transferred to the intensive care unit with a diagnosis of neurobrucellosis. In this case report, we aimed to ensure that neurobrucellosis should be considered as a differential diagnosis in patients presenting with neurological and psychiatric symptoms, especially in regions where animal husbandry is practised. We believe that with this case report, we will contribute to a subject that does not have many examples in the literature and that we will be able to create different perspectives on patients with atypical symptoms

References

  • Naderi H, Sheybani F, Parsa A, Haddad M, Khoroushi F. Neurobrucellosis: report of 54 cases. Trop Med Health. 2022;50(1):77. doi: 10.1186/s41182-022-00472-x.
  • Soares CN, Angelim AIM, Brandão CO, Santos RQ, Mehta R, Silva MTTD. Neurobrucellosis: the great mimicker. Rev Soc Bras Med Trop. 2022;55:e05672021. doi: 10.1590/0037-8682-0567-2021.
  • Demiroğlu YZ, Turunç T, Karaca S, Arlıer Z, Alışkan H, Colakoğlu S, Arslan H. Brusellozda sinir sistemi tutulumu; klinik sınıflama, tedavi ve sonuçlar. Mikrobiyol Bul. 2011;45(3):401-10.
  • Yin J, Gu W, Huan Y, Li Z. Distinctive presentation of neurobrucellosis as myelitis: A case report and literature review. Indian J Pathol Microbiol. 2024 Mar 25. doi: 10.4103/ijpm.ijpm_991_22. Epub ahead of print. PMID: 38563711.
  • Zhuang W, He T, Tuerheng J, He G, Wang BL, Yang YH, et al. Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients. BMC Infect Dis. 2024;24(1):485. doi: 10.1186/s12879-024-09308-x.
  • Li-Di L, Song Z, Yang L, Zhen-Shan L, Yuan-Zhe J, Shao-Kun Z. Surgical Treatment of Brucellar Cervical Epidural Abscess. World Neurosurg. 2024;183:e838-e845. doi: 10.1016/j.wneu.2024.01.040.
  • Liu Y, Gu Y. Case report: A case of abrupt stroke as the first symptom of neurobrucellosis. Front Neurol. 2023;14:1066042. doi: 10.3389/fneur.2023.1066042.
  • Caylak E. Evaluation of the oxidant/antioxidant status in patients with brucellosis treated with a combination of two types of antibiotics. Ann Clin Anal Med 2022;13(5):583-587 doi: 10.4328/ACAM.21045
  • Li G, Lv D, Yao Y, Wu H, Wang J, Deng S, et al. Overexpression of ASMT likely enhances the resistance of transgenic sheep to brucellosis by influencing immune-related signaling pathways and gut microbiota. FASEB J. 2021;35(9):e21783. doi: 10.1096/fj.202100651R.
  • Ozsoy O, Yildirim FB, Ogut E, Kaya Y, Tanriover G, Parlak H, et al. Melatonin is protective against 6-hydroxydopamine-induced oxidative stress in a hemiparkinsonian rat model. Free Radic Res. 2015;49(8):1004-14. doi: 10.3109/10715762.2015.1027198.

Ajitasyon ile Başvuran Hastada Şaşırtıcı Sonuç: Nörobruselloz

Year 2024, Volume: 6 Issue: 3, 131 - 133, 01.11.2024
https://doi.org/10.38175/phnx.1478894

Abstract

Bruselloz dünya çapında görülen en yaygın zoonotik hastalıklardandır. Nörobruselloz, brusella tanısı alındıktan sonra yaklaşık 12 ay içerisinde ortaya çıkar. Bruselloza bağlı menenjit olgularında, menenjitin klasik triadı (ateş, ense sertliği, bilinç bulanıklığı) nadir görüldüğünden, endemik bölgelerde açıklanmayan nörolojik bulguları olan hastaların ayırıcı tanısında bruselloz mutlaka düşünülmelidir. Olgumuzda; tıbbi geçmişinde kronik hastalık öyküsü bulunmayan 31 yaşında bir erkek hasta, aynı gün başlayan ajitasyon, bilinç bulanıklığı, anlamsız hareketler, yürümede dengesizlik, görmede bulanıklık ile acil servise müracaat etti. Anamnezinde 8 ay önce dış merkezde brucella tedavisi gördüğü ancak tedavisine düzenli devam etmediği ve takiplerine gitmediği öğrenildi. LP sonucunda mikroprotein 255 mg/dL ve albümin 114 mg/dL saptandı. BOS brucella aglütinasyonu 1/40 titrede pozitif geldi. Hasta nörobruselloz tanısı ile yoğun bakım ünitesine devredildi. Bu olgu sunumunda özellikle hayvancılıkla uğraşılan bölgelerde nörolojik ve psikiyatrik semptomlarla gelen hastalarda nörobrusellozun ayırıcı tanı olarak düşünülmesini sağlamayı amaçladık. Bu olgu sunumu ile literatürde çok fazla örneği olmayan bir konuya katkı sağlayacağımızı ve atipik semptomlar barındıran hastalarda farklı bakış açıları oluşturabileceğimizi düşünmekteyiz.

References

  • Naderi H, Sheybani F, Parsa A, Haddad M, Khoroushi F. Neurobrucellosis: report of 54 cases. Trop Med Health. 2022;50(1):77. doi: 10.1186/s41182-022-00472-x.
  • Soares CN, Angelim AIM, Brandão CO, Santos RQ, Mehta R, Silva MTTD. Neurobrucellosis: the great mimicker. Rev Soc Bras Med Trop. 2022;55:e05672021. doi: 10.1590/0037-8682-0567-2021.
  • Demiroğlu YZ, Turunç T, Karaca S, Arlıer Z, Alışkan H, Colakoğlu S, Arslan H. Brusellozda sinir sistemi tutulumu; klinik sınıflama, tedavi ve sonuçlar. Mikrobiyol Bul. 2011;45(3):401-10.
  • Yin J, Gu W, Huan Y, Li Z. Distinctive presentation of neurobrucellosis as myelitis: A case report and literature review. Indian J Pathol Microbiol. 2024 Mar 25. doi: 10.4103/ijpm.ijpm_991_22. Epub ahead of print. PMID: 38563711.
  • Zhuang W, He T, Tuerheng J, He G, Wang BL, Yang YH, et al. Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients. BMC Infect Dis. 2024;24(1):485. doi: 10.1186/s12879-024-09308-x.
  • Li-Di L, Song Z, Yang L, Zhen-Shan L, Yuan-Zhe J, Shao-Kun Z. Surgical Treatment of Brucellar Cervical Epidural Abscess. World Neurosurg. 2024;183:e838-e845. doi: 10.1016/j.wneu.2024.01.040.
  • Liu Y, Gu Y. Case report: A case of abrupt stroke as the first symptom of neurobrucellosis. Front Neurol. 2023;14:1066042. doi: 10.3389/fneur.2023.1066042.
  • Caylak E. Evaluation of the oxidant/antioxidant status in patients with brucellosis treated with a combination of two types of antibiotics. Ann Clin Anal Med 2022;13(5):583-587 doi: 10.4328/ACAM.21045
  • Li G, Lv D, Yao Y, Wu H, Wang J, Deng S, et al. Overexpression of ASMT likely enhances the resistance of transgenic sheep to brucellosis by influencing immune-related signaling pathways and gut microbiota. FASEB J. 2021;35(9):e21783. doi: 10.1096/fj.202100651R.
  • Ozsoy O, Yildirim FB, Ogut E, Kaya Y, Tanriover G, Parlak H, et al. Melatonin is protective against 6-hydroxydopamine-induced oxidative stress in a hemiparkinsonian rat model. Free Radic Res. 2015;49(8):1004-14. doi: 10.3109/10715762.2015.1027198.
There are 10 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Case Reports
Authors

Gözde Yılmaz 0009-0003-0032-4398

Ayşegül Eylem Özer 0009-0001-8041-9770

Rukiye Aytekin 0009-0007-7139-1562

Haticenur Yıldırım 0009-0003-9990-6928

Necmi Baykan 0000-0002-6845-9550

Early Pub Date October 30, 2024
Publication Date November 1, 2024
Submission Date May 5, 2024
Acceptance Date September 3, 2024
Published in Issue Year 2024 Volume: 6 Issue: 3

Cite

Vancouver Yılmaz G, Özer AE, Aytekin R, Yıldırım H, Baykan N. Surprising Result in A Patient Presenting with Agitation: Neurobrucellosis. Phnx Med J. 2024;6(3):131-3.

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