Abducens nerve palsy and optic neuritis as initial manifestation in brucellosis

Abstract

Cranial nerve involvement in brucellosis is rare. We present a case of brucellosis presenting with optic neuritis and abducens nerve palsy on the left side. Cerebrospinal fluid findings indicated Brucella meningitis with high protein count, low sugar level and pleocystosis. In addition, Brucella agglutination test (Wright test) was found to be 1/128 in cerebrospinal fluid. Serum agglutination test for Brucella was also positive at 1/1280. This case was diagnosed as brucellosis involving optic and abducens nerves. The patient was treated by ceftriaxone (intravenous), rifampicin (orally) and doxycycline (orally). Two months later the patient's vision acuity in the left eye had moderately improved and the patient's left abducens palsy had almost disappeared. In conclusion, cranial nerve involvement in brucellosis can have good prognosis if anti-Brucella treatment is undertaken early.

Ophthalmoparesis, papillitis and premacular hemorrhage in a case with endocarditis: A rare presentation of Brucellosis

“…[7] Premacular hemorrhage detected in the right eye of our patient was considered to be related to an embolic process from the vegetation on the aortic valve. Cranial nerve involvement in neurobrucellosis has been reported previously,[8] however, neurobrucellosis and endocarditis complicated by premacular hemorrhage in our case from an endemic region was considered as a rare condition. Our patient showed dramatic clinical improvement after surgical removal of vegetation and replacement of aortic valve followed by specific treatment with rifampin and doxycycline for brucella.…”

An Interesting Case of Neurobrucellosis Mimicking Neuropsychiatric Lupus

“…Neurobrucellosis manifesting as vasculitis, as seen in our patient, is an unusual but well-described manifestation of brucellosis [ 8 , 12 ]. While studies of patients with neurobrucellosis have shown the most commonly affected cranial nerve is VIII [ 1 , 10 ], and involvement of optic nerve secondary to vasculitis has been documented [ 10 , 15 , 18 ].…”

Metagenomic Next-Generation Sequencing to Investigate Infectious Endophthalmitis of Brucella: A Case Report

“…Choroiditis can also be induced by brucella, which is usually manifested as multifocal lesions or nodular or geographic changes ( 14 ). In addition, optic neuropathy has also been found in some brucella patients, which can be manifested as optic nipple hyperemia, retrobulbar optic neuritis, papilledema, and so on ( 15 ). Other manifestations of ocular brucellosis include endophthalmitis, lacrimal gland inflammation, episcleritis, keratitis, conjunctivitis, intracranial nerve palsy, and so on ( 16 , 17 ).…”