Think about Neurobrucellosis; When a Man Cries!: A Case Study

ARTICLE INFO ABSTRACT Article history: Received 25 September 2015 Accepted 28 November 2015 Available online 1 December 2015 Neurobrucellosis (NB) is a rare and severe form of systemic Brucella infection. We introduced an unusual case that “Psychologic Symptoms” was the most prominent complaints of his family. He was a 50-year-old man who has worked in butchery. His problems had begun 2 months prior to his admission with mood disorders, arthralgia, weakness, headache and night sweats; he has recurrent crying with no obvious environmental problem! Wright agglutination test, Coomb’s Wright and 2ME were negative 2 times in outpatient work-ups and the other lab tests weren’t useful in diagnosis. Treatment trials for acute sinusitis and aseptic meningitis have had some improvements of symptoms but his clinical condition was not acceptable. A brain MRI was performed and the results indicated few T2W hyper-signal points of white matter specially periventricular. Brucellosis serologic tests were requested “for third time” and the results were positive. The patient was treated with cotrimoxazole, doxycycline, and rifampicin for 6 months. Two weeks after this treatment, all of mentioned symptoms subsided. Six weeks after treatment the brain MRI was repeated, and the previously seen lesions had improved. The lumber puncture 3 months after treatment was repeated and results were normal. It is concluded that when a patient in an endemic area suffers from chronic mood disorders, headache, fever, and other non-specific manifestations that cannot be explained by other etiologies, it may be a case of NB. In this case, the “repeated” Wright test and excellent response to NB treatment would confirm the diagnosis.