A Brucellosis Febrile Syndrome Following Meningeal Involvement

Neurobrucellosis (NB) is an uncommon presentation even in countries where brucellosis is endemic; only a few cases have been reported. We report a case of a 23-year-old female who presented with typical symptoms of brucellosis including fever, night sweets, anorexia, back pain and weight loss. Her blood culture grew Brucella melitensis and the serology tested strongly positive for brucella antibodies. The patient was treated initially with doxycycline and rifampicin and then was put on doxycycline and trimethoprim-sulfamethaxazole (TMP-SMX) due to drug-induced hepatitis secondary to rifampicin. Later on, she got pregnant and was lost to follow up. She presented one week post-partum with fever and severe frontal headaches in which a contrast-enhanced magnetic resonance imaging (MRI) brain was obtained and revealed diffuse meningeal enhancement involving the anterior and posterior fossa consistent with pachymeningeal enhancement. The patient was treated with doxycycline, gentamycin and ceftriaxone. Follow up MRI showed marked improvement of the meningeal enhancement that was previously observed.