A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review

doi:10.3969/j.issn.1004-583X.2023.12.008

Abstract

Abstract:

Objective To explore the clinical features, diagnosis and treatment of neurobrucellosis (NB), and to analyze the causes of misdiagnosis of NB as amyotrophic lateral sclerosis (ALS). To compare the common points between NB and ALS and how to identify them in clinical work. Methods The clinical characteristics and treatment of a patient with NB misdiagnosed as ALS were reported and analyzed in combination with literature review. Results A 58-year-old male patient diagnosed with NB had significantly alleviated symptoms after 2 weeks of treatment, with right proximal limb muscle strength of grade Ⅴ^-, distal muscle strength of grade Ⅳ^-, left proximal muscle strength of grade Ⅴ^-, left distal muscle strength of grade Ⅴ^-, bilateral tendon reflexes (+++), and bilateral Babinski's sign (+). He was referred back to the local hospital for continuing anti-Brucella treatment. Conclusion Misdiagnosis of NB as ALS is mainly attributed to the atypical and diverse symptoms and signs of NB, and non-specific signs of intracranial infection, leading to misdiagnosis of other neurological diseases.

Key words: brucellosis, amyotrophic lateral sclerosis, peripheral nervous system disease

CLC Number:

R516.7

Chun Mei, Zhen Jin, Yan Yan, Liu Bin, Li Min, Sun Xia. A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review[J]. Clinical Focus, 2023, 38(12): 1101-1106.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.12.008

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I12/1101

Figures/Tables 7

References 25

[1]	张文宏, 张跃新. 布鲁菌病诊疗专家共识[J]. 中华传染病杂志, 2017, 35(12):705-710.
[2]	Jiang H, O'Callaghan D, Ding JB. Brucellosis in China: History, progress and challenge[J]. Infect Dis Poverty, 2020, 9(1):55. doi: 10.1186/s40249-020-00673-8 pmid: 32448394
[3]	Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis[J]. Lancet Infect Dis, 2006, 6(2): 91-99. doi: 10.1016/S1473-3099(06)70382-6 pmid: 16439329
[4]	Patra S, Kalwaje Eshwara V, Pai AR, et al. Evaluation of clinical, diagnostic features and therapeutic outcome of neurobrucellosis: A case series and review of literature. Int[J]Neurosci, 2022, 132(11):1080-1090.
[5]	周如梦, 卢祖能. 下运动神经元综合征的诊疗思路[J]. 卒中与神经疾病, 2020, 27(2):279-282.
[6]	Vazquez-Costa JF, Mazon M, Carreres-Polo J, et al. Brain signal intensity changes as biomarkers in amyotrophic lateral sclerosis[J]. Acta Neurol Scand, 2018, 137(2): 262-271. doi: 10.1111/ane.2018.137.issue-2 URL
[7]	王瑞莉, 冯金平, 隋玲玲, 等. 肌萎缩侧索硬化三例误诊分析[J]. 脑与神经疾病杂志, 2011, 19(4):284-287.
[8]	Tan MB, Mcadory LE. Capecitabine-induced leukoencephalopathy involving the bilateral corticospinal tracts[J]. J Radiol Case Rep, 2016, 10(3): 1-10.
[9]	Mastrangelo V, Asioli GM, Foschi M, et al. Bilateral extensive corticospinal tract lesions in MOG antibody-associated disease[J]. Neurology, 2020, 95(14): 648-649. doi: 10.1212/WNL.0000000000010662 URL
[10]	袁剑颖. 基于宏基因组高通量测序的病原微生物检测方法研究与开发[D]. 华南理工大学, 2018.000080.
[11]	Naderi H, Sheybani F, Parsa A, et al. Neurobrucellosis: Report of 54 cases[J]. Trop Med Health, 2022, 50(1):77. doi: 10.1186/s41182-022-00472-x
[12]	董益闻, 郭文洁. 布氏杆菌病的临床诊断与防控策略[J]. 今日畜牧兽医, 2020, 36(4):19.
[13]	Strickland AB, Shi M. Mechanisms of fungal dissemination[J]. Cell Mol Life Sci, 2021, 78(7):3219-3238. doi: 10.1007/s00018-020-03736-z pmid: 33449153
[14]	Miraglia MC, Rodriguez AM, Barrionuevo P, et al. Brucella abortus traverses brain microvascular endothelial cells using infected monocytes as a trojan horse[J]. Front Cell Infect Microbiol, 2018, 8:200. doi: 10.3389/fcimb.2018.00200 URL
[15]	Tajerian A, Sofian M, Zarinfar N, et al. Manifestations, complications, and treatment of neurobrucellosis: A systematic review and meta-analysis[J]. Int J Neurosci, 2022:1-11.
[16]	Dar W, Wani M, Mir F, et al. Isolated neurobrucellosis-characteristic clinical and laboratory features[J]. Acta Neurol Belg, 2022, 122(6):1469-1475. doi: 10.1007/s13760-020-01573-2
[17]	Guven T, Ugurlu K, Ergonul O, et al. Neurobrucellosis: Clinical and diagnostic features[J]. Clin Infect Dis, 2013, 56(10): 1407-1412. doi: 10.1093/cid/cit072 pmid: 23446629
[18]	Zheng N, Wang W, Zhang JT, et al. Neurobrucellosis[J]. Int J Neurosci, 2018, 128(1): 55-62. doi: 10.1080/00207454.2017.1363747 pmid: 28768443
[19]	Kizilkilic O, Calli C. Neurobrucellosis[J]. Neuroimaging Clin N Am, 2011, 21(4): 927-937. doi: 10.1016/j.nic.2011.07.008 URL
[20]	Ata F, Yousaf Z, Sharif MK, et al. Demyelinating steroid-responsive neurobrucellosis[J]. BMJ Case Rep, 2020, 13(3):e233798. doi: 10.1136/bcr-2019-233798 URL
[21]	Dhar D, Jaipuriar RS, Mondal MS, et al. Pediatric neurobrucellosis: A systematic review with case report[J] Trop Pediatr, 2022, 69(1):fmad004.
[22]	Yamout BI, Massouh J, Hushaymi I, et al. Neurobrucellosis presenting as longitudinally extensive transverse myelitis: A case report and review of the literature[J]. Mult Scler Relat Disord, 2020; 40:101947. doi: 10.1016/j.msard.2020.101947 URL
[23]	Liu Y, Gu Y. Case report: A case of abrupt stroke as the first symptom of neurobrucellosis[J]. Front Neurol, 2023, 22; 14:1066042.
[24]	Dean AS, Crump L, Greter H, et al. Clinical manifestations of human brucellosis: A systematic review and meta-analysis[J]. PLoS Negl Trop Dis, 2012, 6(12): e1929.
[25]	王丹, 赵世刚. 神经型布氏杆菌病的研究进展与分析[J]. 中国人兽共患病学报, 2017, 33(10):927-932.

神经	节段	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mVms)	速度(m/s)
左正中神经	腕	5.67	5.63	0.70	2.12
	肘→腕	11.20	8.00	0.31	0.89	38.2
右正中神经	腕	9.92	5.18	0.16	0.62
	肘→腕	19.50	9.80	0.02	0.05	21.4
左尺神经	腕	3.17	4.66	1.48	3.30
	肘下→腕	5.92	5.38	1.12	3.10	58.2
	肘上→肘下	8.92	5.38	0.91	2.82	36.7
右尺神经	腕	4.75	3.92	0.28	0.47
	肘下→腕	8.17	3.13	0.25	0.36	41.00
	肘上→肘下	10.30	3.00	0.24	0.33	53.1
右腓总神经	踝前	4.00	5.75	0.69	1.94
	腓骨小头下→踝前	5.58	5.72	0.67	2.02	37.9
左胫神经	内踝	4.17	4.58	2.04	3.81
	腘窝→内踝	13.60	5.20	1.37	3.45	38.2
右胫神经	内踝	3.92	5.66	1.26	3.19
	腘窝→内踝	12.30	5.90	0.84	1.83	42.00

神经	节段	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mVms)	速度(m/s)
左正中神经	腕	5.67	5.63	0.70	2.12
	肘→腕	11.20	8.00	0.31	0.89	38.2
右正中神经	腕	9.92	5.18	0.16	0.62
	肘→腕	19.50	9.80	0.02	0.05	21.4
左尺神经	腕	3.17	4.66	1.48	3.30
	肘下→腕	5.92	5.38	1.12	3.10	58.2
	肘上→肘下	8.92	5.38	0.91	2.82	36.7
右尺神经	腕	4.75	3.92	0.28	0.47
	肘下→腕	8.17	3.13	0.25	0.36	41.00
	肘上→肘下	10.30	3.00	0.24	0.33	53.1
右腓总神经	踝前	4.00	5.75	0.69	1.94
	腓骨小头下→踝前	5.58	5.72	0.67	2.02	37.9
左胫神经	内踝	4.17	4.58	2.04	3.81
	腘窝→内踝	13.60	5.20	1.37	3.45	38.2
右胫神经	内踝	3.92	5.66	1.26	3.19
	腘窝→内踝	12.30	5.90	0.84	1.83	42.00

神经	刺激部位	记录部位	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mV/ms)	距离(mm)	速度(m/s)
左正中神经	中指	腕	2.50	1.47	2.38	1.70	115	46.00
右正中神经	中指	腕	2.60	1.27	7.36	4.75	120	46.20
左尺神经	小指	腕	1.83	1.24	6.92	4.05	95	51.80
右尺神经	小指	腕	1.93	1.34	9.11	6.75	100	51.70
左腓肠神经	跟骨上14 cm	外踝	2.00	1.30	11.80	7.39	110	55.00
右腓肠神经	跟骨上14 cm	外踝	2.20	1.20	7.97	4.90	130	59.10
右腓浅神经	腓骨长肌	足背	1.97	1.16	12.60	7.53	95	48.30

神经	刺激部位	记录部位	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mV/ms)	距离(mm)	速度(m/s)
左正中神经	中指	腕	2.50	1.47	2.38	1.70	115	46.00
右正中神经	中指	腕	2.60	1.27	7.36	4.75	120	46.20
左尺神经	小指	腕	1.83	1.24	6.92	4.05	95	51.80
右尺神经	小指	腕	1.93	1.34	9.11	6.75	100	51.70
左腓肠神经	跟骨上14 cm	外踝	2.00	1.30	11.80	7.39	110	55.00
右腓肠神经	跟骨上14 cm	外踝	2.20	1.20	7.97	4.90	130	59.10
右腓浅神经	腓骨长肌	足背	1.97	1.16	12.60	7.53	95	48.30

神经	刺激部位	平均潜伏期 (ms)	最短潜伏期 (ms)	最长潜伏期 (ms)	F游标潜伏期 (ms)	F-M潜伏期 (ms)	出现率 (%)
左正中神经	腕	29.6	17.6	35.7	29.6	28.9	60%
右正中神经	腕	31.3	31.3	31.3	31.3	30.6	100%
左尺神经	腕	30.5	30.5	30.5	30.7	30	100%
右尺神经	腕	NA	NA	NA	17.6	16.9	NA
右腓总神经	外踝	NA	NA	NA	19.2	18.5	NA
左胫神经	内踝	41.3	17.6	52.9	48.7	46.2	100%
右胫神经	内踝	47.8	47.8	47.8	47.0	46.1	100%