Unilateral Optic Neuritis as a Presentation of Neurobrucellosis
Brucellosis is an infectious disease due to the bacteria Brucella that causes rising and falling fevers, sweats, weakness, headache, muscle pain and back pain. Involvement of Central Nervous System causes Neurobrucellosis resulting in serious complications of brucellosis infection like meningitis, stroke, cranial nerve lesions, or mycotic aneurysms. This condition usually requires treatment with antibiotics that cross the blood-brain barrier. Neurobrucellosis is very rare and is present in only 2% of the children with Brucellosis. Case Report:
This literature reviewed a case of neurobrucellosis optic neuritis in an 11 year old girl with no significant medical history, except for a vacation in Portuguese countryside where she consumed unpasteurized dairy products. She was admitted in the hospital with headache, retroorbital pain and acute right eye visual impairment. Doctors found feverish body temperature, mild edema in her right tibiotarsal joint and afferent papillary defect. The corrected vision was 20/30 and all the neurologic exams were normal.
Noticing the post-infectious optic neuritis, physicians introduced a one-day dose of methylprednisolone (250 mg, 6/6h). Further investigations revealed a 1/640 titer of Brucella serum agglutination and a slight pleocytosis of the cerebrospinal fluid with mature white blood cells. Thus Antibiotic therapy with Doxycycline (200 mg/d) and Rifampicin (600 mg/d) was initiated for 6 months. Discussion:
Two things indicated that the optic neuritis was due to Neurobrucellosis. First, agglutination titer findings for Brucella that was greater than 1:160 (normal cerebrospinal fluid) disclosed inflammation in the Central Nervous System; Second, the ingestion of untreated milk in an endemic country. After 6 months of appropriate treatment all symptoms were resolved.
Although not so common but it was a very fascinating...
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