Neurobrucellosis and Multiple Sclerosis: Cause, Confounder, or Coincidence?

Abstract

We report the case of a 17-year-old girl who was initially diagnosed with multiple sclerosis based on clinical and radiological findings and later confirmed to have neurobrucellosis via cerebrospinal fluid Brucella polymerase chain reaction positivity. Magnetic resonance imaging revealed demyelinating lesions consistent with multiple sclerosis, and Brucella infection due to epidemiological exposure was suspected. To the best of our knowledge, this is the first pediatric report of coexisting neurobrucellosis and multiple sclerosis. It underscores the diagnostic challenges in distinguishing between infectious and autoimmune demyelinating disorders, particularly in endemic regions, and highlights the importance of a comprehensive evaluation of atypical presentations.

FIGURE 1:. Pretreatment cranial MRI findings of the patient. (A-B): T2-weighted FLAIR MRI images revealed multiple demyelinating plaques in the bilateral frontoparietotemporal regions. The coronal image (A): shows hyperintense lesions (arrows) in both juxtacortical and deep white matter, oriented perpendicular to the lateral ventricles. The sagittal image (B): demonstrates the characteristic “Dawson’s fingers” (arrow), indicative of perivenular demyelination. An asterisk (*) marks an artifact caused by the patient's dental braces. (C-D): Sagittal T1-weighted images before and after contrast administration demonstrate no enhancement on the precontrast image (C, arrow), while the post-contrast image (D, arrow) reveals a 10 mm enhancing lesion consistent with active demyelination following intravenous gadolinium administration. (E-F): Demyelinating plaques at the cervical (arrows in E) and thoracic (arrows in F) levels.

FIGURE 2:. (A-B): Post-treatment images obtained after 2 weeks of antimicrobial therapy show a subtle reduction in the size and signal intensity of the previously observed periventricular white matter lesions, suggesting mild radiological improvement.

FIGURE 3:. Follow-up sagittal T1-weighted images obtained after 1 month of antimicrobial therapy. The precontrast image (A): shows no visible lesion, and the post-contrast image (B): demonstrates no enhancement at the site of the previously observed lesion (arrow), indicating resolution of contrast uptake and radiological improvement.