Neurobrucellosis mimicking demyelinating disease

• Published in: Multiple sclerosis 2008-09, Vol.14, p.S224-S224
• Main Authors: Tuerkoglu, R, Ceran, N, Gencer, M, Tutkavul, K, Tireli, H
• Format: Article
• Language: English
• Subjects: Brucella
• ISSN: 1352-4585

Background: Brucellosis is still common in developing countries. Acute, subacute or chronic meningitis, meningoencephalitis, polyradiculoneuritis, myelitis and involvement of cranial nerves are the most common features of neurobrucellosis. Bacterial infection might trigger an immune mechanism leading to demyelination in a portion of chronic neurobrucellosis cases. Objective: Neurobrucellosis should be considered in the differential diagnosis of demyelinating disease in Turkey because of its endemic nature. Methods: This prospective study included 14 consecutive patients with neurobrucellosis diagnosed and treated between 2002 and 2006 at the Haydarpasa Numune Education and Research Hospital. Seven patients were male and seven were female. Seven were followed in infectious disease clinics and the other seven patients were followed in neurology clinics. All patients had diagnostic criteria for neurobrucellosis. In all patients, neuroimaging techniques, such as computed topography and magnetic resonance imaging were performed at the onset of illness and during the following period. Results: The cases were classified into two different clinical categories. The first group had meningovascular complications as prominent signs. The patients had presented with some symptoms such as fever, stiff neck and cranial nerve palsies. The second clinical group had implied diffuse central nervous system involvement. In this group, brain or spinal cord involvement were prominent signs. The patients presented with symptoms such as cerebellar dysfunctions, transverse myelitis, neuro-sensorial deafness, hemiplegia and aphasia. In seven patients, serum cultures were positive for Brucella species. Oligoclonal bands were negative in all these patients. The pathologies that were observed in neuroradiological examinations consisted of meningeal contrast enhancement, white matter changes and vascular changes that correlated with the clinical manifestations. Conclusions: Neurobrucellosis may appear with different clinical manifestations and mimicking multiple sclerosis. The diagnosis may be difficult. Early diagnosis and early treatment is effective on the progress of neurobrucellosis.