[Primary chronic neurobrucellosis]

Brucellosis involving the nervous system usually shows meningomyelitis and/or radiculoneuritis and can by their clinical appearance not be differentiated from other chronic proliferative diseases of the nervous system. Sporadic cases can only be suspected on clinical grounds if a previous exposition is known. The cerebrospinal fluid showing a proliferative or granulomatous cytological picture is strongly suggestive of the diagnosis, which is confirmed by two rising titer values in the complement binding reaction for Brucella-specific antigen. The agglutination method of Widal is not reliable due to blocking incomplete antibodies. A 46 year-old man developed a transverse myelitis within several months accompanied by fluctuating meningeal signs, segmental irritation and transient cranial nerve palsies. No involvement of other organs and no general symptoms of infectious diseases were seen throughout the clinical course. Most importantly, starting treatment as early as possible is decisive for the outcome using a combination of streptomycin, sulfonamides, gentamycin, rifampicin and tetracyclines.