Isolated oculomotor nerve palsy as the sole presenting feature of neurobrucellosis: a case report

Neurobrucellosis is a rare complication of Brucella infection that usually presents with meningitis or meningoencephalitis. We describe a 49-year-old cattle farmer from an endemic region who presented with acute binocular diplopia and pupil-sparing oculomotor nerve palsy, without systemic symptoms and with normal neuroimaging. Diagnosis was based on elevated serum agglutination titers and cerebrospinal fluid abnormalities after exclusion of structural and vascular causes. Combination antibiotic therapy with adjunctive corticosteroids resulted in complete resolution of ocular deficits within three months. This case underscores the need to consider neurobrucellosis in isolated oculomotor nerve palsy despite unremarkable imaging when epidemiological exposure is present.