title: Irreversible papillitis and ophthalmoparesis as a presenting manifestation of neurobrucellosis.
abstract: A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.
authors.affiliation: Department of Neurology (Medicine), Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
authors.forename: Francisco Ruiz
authors.initials: FR
authors.lastname: Miyares
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.forename: Sittana S
authors.initials: SS
authors.lastname: ElShafie
authors.forename: Frank
authors.initials: F
authors.lastname: Equia
authors.forename: Boulenouar
authors.initials: B
authors.lastname: Mesraoua
authors.forename: Hassan
authors.initials: H
authors.lastname: Al Hail
authors.forename: Khalid
authors.initials: K
authors.lastname: Salim
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002003:Brucella abortus; D017347:Brucella melitensis; D002006:Brucellosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D009896:Optic Atrophy / Q000175:diagnosis / Q000209:etiology; D010211:Papilledema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012293:Rifampin / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D004318:Doxycycline; D012293:Rifampin; D013307:Streptomycin