A 27-year-old man, recent visitor to the Middle East, presented with 6-week history of fever (up to 102°F) followed by altered behavior and left hemiparesis. CSF was acellular with raised protein (138 mg/dL). CSF bacterial culture was sterile; adenosine deaminase normal (3 U/L); cryptococcal antigen, Venereal Disease Research Laboratory test, and Japanese B serology were negative. HIV serology and vasculitic workup were unremarkable. Serum Brucella agglutination titer was 320 IU (immunoglobulin M fraction 280 IU). Cranial MRI showed nonenhancing bilateral white matter and basal ganglia hyperintensities on T2-weighted images (figure, A–C). The patient was treated with IV ceftriaxone (1 month) along with oral doxycycline and rifampicin (4 months). At 3 months, Brucella agglutination titer was <20 IU and the patient became independent. Follow-up imaging showed a reduction in lesions (figure, D). Brucellosis frequently presents as chronic meningitis along with cranial neuropathies and spinal arachnoiditis.1 Demyelinating lesions are described in neurobrucellosis,1,2 involvement of the deep gray matter being unusual.
Cranial MRI T2-weighted axial (A), T1-weighted axial (B), and T2 fluid-attenuated inversion recovery coronal (C) showing bilateral periventricular and basal ganglia hyperintensities with no contrast enhancement or mass effect. (D) Follow-up imaging at 11 months showing reduction in T2 hyperintensities in the right putamen, left caudate, and periventricular white matter.
AUTHOR CONTRIBUTIONS
Roopa Rajan: data collection, drafting of manuscript. Dheeraj Khurana: revision of manuscript, concept of manuscript. Praveen Kesav: data collection, review of literature.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- © 2013 American Academy of Neurology
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