Pseudotumor cerebri due to brucellosis: A rare case report

Abstract

Neurobrucellosis is a focal form of brucellosis that may be life-threatening if not timely diagnosed and treated. Pseudotumor cerebri (PTC) has rarely been reported as the sole manifestation of brucellosis. A 41-yearold woman came to the hospital with chronic headaches, vertigo, and nausea. She had been experiencing symptoms for 8 months, starting with blurred vision and headache. The diagnosis was pseudotumor cerebri, managed with acetazolamide and topiramate. She had bilateral papilledema but a normal chest and cranial nerves exam. Lab tests were normal except for high ESR. Brain scans showed no issues. A lumbar puncture was done to reduce intracranial pressure. High ICP made CSF shunt necessary to prevent visual loss. However, a serum brucella agglutination test was done due to chronic neurological symptoms and lymphocyte dominance in CSF analysis. A positive result with the Wright test and 2ME titer. After two weeks, the patient was treated with gentamycin, ceftriaxone, doxycycline, and rifampin, and improved without neurosurgical intervention. Here, we have reported a case of brucellosis with severe headaches, progressive visual impairment, and fundoscopic finding of papilledema, later diagnosed as brucellosis-induced PTC.