Brucella brain abscess: a rare but serious neurological complication-case report and literature review

Brucellosis, also known as "undulant fever," is an infection transmitted from animals to humans that is prevalent in the Mediterranean and Middle East regions. Neurobrucellosis occurs in 0.5% to 25% of cases, presenting central nervous system (CNS) symptoms such as meningitis, encephalitis, strokes, and occasionally brain abscesses. This case study of a teenage patient with a Brucella brain abscess aims to enhance understanding of the disease and provide a comprehensive review of the current literature. We followed the CARE checklist guidelines for preparing this manuscript.

A 15-year-old male patient from Tehran presented with back pain and fever persisting for 8 months, accompanied by subsequent development of headache and right-sided weakness. Upon hospitalization, Brucella infection was confirmed through polymerase chain reaction (PCR) testing, and magnetic resonance imaging (MRI) revealed a brain abscess. Following a left temporal craniotomy, Brucella DNA was detected within the lesion. Postoperative improvement was noted in the patient's condition, with normalization of white blood cell counts (WBC) and absence of intracranial brain abscess.

Neurobrucellosis can cause severe complications, but early diagnosis typically leads to good prognosis. Delayed treatment may result in lasting neurological damage necessitating long-term care. This review includes all documented cases of brucellosis brain abscesses from 1989 to 2024, encompassing both children and adolescents, as well as our case treated with antibiotics and surgery.

The treatment of neurobrucellosis can vary significantly, potentially leading to complications arising from brain lesions that require meticulous monitoring. If conservative management proves ineffective, surgical intervention may be necessary. Therefore, it is crucial to distinguish neurobrucellosis imaging from other types of brain lesions.