An Elderly Lady with Neurobrucellosis and Multiple Co-morbid Conditions

Neurobrucellosis is a rare (1.7-7.0% of prevalence) neurological complication of brucellosis which has neither a typical clinical picture nor specific cerebrospinal fluid (CSF) findings and mimics other neurological disorders leading to clinical diagnostic dilemmas. This study describes one elderly patient of neurobrucellosis with fever, irrelevant behavior, sweating, fatigue, drowsiness, neck stiffness inability to speak and reduced activity for about 10 days hailing from Beanibazar, Sylhet, Bangladesh admitted in Mount Adora Hospital, Sylhet, Bangladesh on 16th October 2016. The diagnosis was depended on history, clinical examination, positive brucella test, CSF examination and CT of the brain. Cerebrospinal fluid (CSF) showed an abnormal finding regarding increased cell count, elevated protein levels and low glucose while blood serology was highly reactive. The patient received a combination antibiotic therapy; meropenem (3gm/day) for 15 days, streptomycin for 21 days, doxycycline 200mg/day for 6 weeks and rifampicin 600mg/day for 3 months. The complete improvement in patient's condition after a long lasting and difficult to diagnose illness motivated author to report this case. As neurobrucellosis is a fatal condition if remained untreated and should be considered as one of the differential diagnoses in unusual cases of neurologic and psychiatric disorders and in cases of neurological dysfunction in absence of any other suitable alternative diagnosis.