Vascular occlusion: Atypical presentation of neurobrucellosis as a sequelae to <i>Brucella abortus</i> infection

Vascular occlusion: Atypical presentation of neurobrucellosis as a sequelae to Brucella abortus infectionNeurobrucellosis is a serious complication of brucellosis, a zoonotic infection caused primarily by Brucella melitensis. 1 It accounts for 5%-7% of brucellosis cases, has varied clinical features and may manifest as part of systemic brucellosis or as isolated disease. 2,3A 23-year-old male presented with a history of fever for 7 days and decreased communication, along with abnormal behaviour for 1 day.He lived in a rural area and reared livestock, but did not consume raw milk.On examination, the patient was agitated and disoriented.His lower limbs had increased tone, neck rigidity was present, and the Babinski was bilateral extensor.All other systems were within normal limits.His haemoglobin was 13.7 g/dl, and leucocyte count was 5610/cmm.Liver function, renal function, urine analysis, and serum electrolytes were normal.Cerebrospinal fluid (CSF) analysis showed proteins: 198 mg/dl; glucose: 18 mg/dl (concomitant blood glucose 117 mg/dl), adenosine deaminase: 3.2 U/L, and microscopy: total leucocyte count of 260 cells/cmm with lymphocytic pleocytosis.Initial CSF culture was sterile and negative for herpes simplex virus 1 and 2, and cryptococcus.A cartridge-based nucleic acid amplification test on CSF was negative.The chest X-ray was normal.Tuberculin sensitivity and IFNg release assay were also negative.Vasculitis work-up (antinuclear antibody, perinuclear anti-neutrophil cytoplasmic antibody, cytoplasmic antineutrophil cytoplasmic antibody) was negative.The neuroimaging findings are shown in Figs.1-3.Serology was positive for Brucella via Rose Bengal Test (RBT) (Fig. 4), with borderline IgM and positive IgG antibodies.CSF polymerase chain reaction (PCR) confirmed Brucella, with serum agglutination test titre of 1:80.Cultures yielded Brucella abortus (Fig. 5), with speciation confirmed through PCR (Figs.6,7).The patient was started on ceftriaxone, doxycycline, and rifampicin.At discharge, the