An unusual case of neurobrucellosis with intracranial hypertension and bilateral abducens nerve palsy

Brucellosis is one of the most common zoonotic diseases in the world and it can affect many systems. Rarely, central nervous system involvement, which is a serious complication, can be observed. Here, we report a case of neurobrucellosis presenting with abducens nerve palsy and intracranial hypertension. A 28-year-old woman engaged in livestock farming. She presented to the emergency department with left-sided weakness, nausea, and vomiting. Neurological examination showed 4/5 muscle strength in the left upper extremity without meningeal signs. Neurobrucellosis was confirmed based on positive Brucella immunocapture (1:5120) and cerebrospinal fluid (CSF) agglutination (1:320) tests. Antimicrobial therapy with ceftriaxone, doxycycline, and rifampicin was initiated. On the 11th day, the patient developed sudden diplopia, and fundoscopic examination revealed bilateral papilledema. Lumbar puncture demonstrated elevated CSF pressure (27 cm/H₂O), indicating intracranial hypertension, while ocular findings were consistent with bilateral abducens nerve palsy as complications of neurobrucellosis. Methylprednisolone and acetazolamide were subsequently added to the treatment regimen. Following clinical improvement, the patient was discharged on day 40. At the third month of follow up, as intracranial pressure normalized, methylprednisolone and acetazolamide were discontinued. Ceftriaxone was replaced with trimethoprim-sulfamethoxazole on day 60. The treatment was ceased at 12th month, with the patient remaining asymptomatic and exhibiting normal findings. Two-year follow-up confirmed complete recovery with no recurrence. This case emphasizes that neurobrucellosis should be considered in patients with neurological manifestations, such as cranial nerve palsy and intracranial hypertension, particularly in endemic regions, and illustrates that timely diagnosis and appropiate antimicrobial and adjunctive therapy can result in complete recovery without long-term sequelae.