Brucellosis with Multisystem Involvement: A Case Report Focusing on Neurological Manifestations and Drug-Induced...

Brucellosis is a widespread zoonotic infection with a broad spectrum of clinical manifestations, often leading to delayed diagnosis and multisystem complications. While typical symptoms include fever, arthralgia, and hepatosplenomegaly, neurological involvement and severe drug reactions are uncommon and pose diagnostic and therapeutic challenges. A 54-year-old male farmer from an endemic area in Inner Mongolia presented with a six-month history of recurrent polyarthralgia, followed by progressive neurological deficits including muscle weakness, sensory impairment, and bilateral adductor pollicis atrophy. Despite confirmed brucellosis serology and standard antibiotic therapy (rifampicin and doxycycline), his symptoms persisted. He later developed generalized drug-induced dermatitis after taking Zhenbao Pill, which resolved only partially upon discontinuation. Lumbar magnetic resonance imaging (MRI) showed multilevel intervertebral disc protrusion, and brain MRI revealed cerebral white matter hyperintensities and small lacunar infarcts. Given the patient's epidemiological exposure history, progressive clinical symptoms and abnormal imaging findings, suspected neurobrucellosis and possible brucellosis-associated neuropathy were considered clinically, with definitive diagnosis pending further cerebrospinal fluid examination, nerve conduction studies and electromyography. This case highlights the clinical possibility of progressive neurological impairment and potential herbal medicine-related cutaneous adverse reactions in patients with brucellosis. The novelty of this case lies in the co-occurrence of suspected brucellosis-related neurological involvement and drug/herbal-induced dermatitis. This study reminds clinicians to enhance vigilance against atypical and complex manifestations of brucellosis, conduct comprehensive differential diagnosis, and adopt a multidisciplinary collaborative strategy for the standardized management of such intractable cases.