title: Neurobrucellosis presenting with hearing loss, gait disturbances and diffuse white matter disease on brain magnetic resonance imaging (MRI).
abstract: OBJECTIVE
  To report an unusual case of neurobrucellosis.
  
  
  METHODS
  A 48-year-old man was admitted to Rafik Hariri University Hospital (RHUH) for progressive gait disturbances, hearing loss, and some episodes of chills without documented fever. The neurological examination showed gait ataxia, tremor in the legs and mild cognitive decline. The physical exam was otherwise normal.
  
  
  RESULTS
  Magnetic resonance imaging (MRI) of brain showed diffuse, bilateral, confluent, subcortical, and periventricular white matter disease. Serum agglutination test (SAT) for Brucella was positive in blood and cerebrospinal fluid (CSF). The patient was treated with a combination of ceftriaxone for one month, and doxycycline and rifampicin for one year and his condition stabilized. Literature review was performed. The possible underlying pathophysiological mechanisms are discussed.
  
  
  CONCLUSIONS
  Neurobrucellosis is a very rare complication of human brucellosis, and can present with a variety of central nervous system symptomatology (CNS) and MRI changes suggestive of leukoencephalopathy. Its diagnosis could be challenging and should always be suspected in patients presenting with CNS manifestations and/or diffuse white matter disease visualized on brain MRI, especially in Brucella endemic areas.
authors.affiliation: Faculty of Clinical Medicine, University of Balamand & Department of Neurology, St George Hospital University Medical Center, Beirut, Lebanon. rosette.jabbour@balamand.edu.lb
authors.forename: Rosette A
authors.initials: RA
authors.lastname: Jabbour
authors.forename: Zuhayr
authors.initials: Z
authors.lastname: Tabbarah
mesh_terms: D002006:Brucellosis / Q000150:complications / Q000175:diagnosis*; D020806:Central Nervous System Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology; D034381:Hearing Loss / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged