Neurobrucellosis manifesting as secondary hemiparkinsonism in a veterinary technician: A case report and evidence-based review

Abstract

Background:: Neurobrucellosis is a severe complication of brucellosis, occurring in 3%–10% of systemic cases. Movement disorders, particularly parkinsonism, are rare manifestations that present significant diagnostic challenges and are often associated with occupational exposure. Case Presentation:: We report the case of a 51-year-old male veterinary technician who developed progressive right hemiparkinsonism over two years, accompanied by systemic symptoms including fever, weight loss, and arthralgia. Diagnosis was established through characteristic cerebrospinal fluid (CSF) findings of lymphocytic pleocytosis, positive CSF and serum serology for Brucella, and definitive molecular confirmation with a positive CSF polymerase chain reaction (PCR) for Brucella DNA. Dopamine transporter single-photon emission computed tomography (DaT-SPECT) revealed an atypical pattern of nigrostriatal dopaminergic deficit, supporting a secondary cause. The patient was treated with a six-month, ceftriaxone-based triple-antibiotic regimen and symptomatic levodopa/carbidopa. This resulted in the resolution of systemic symptoms and significant functional recovery, with mild residual parkinsonian features at 24-month follow-up. Conclusions:: This case highlights neurobrucellosis as a critical differential diagnosis for atypical parkinsonism, particularly in patients with a relevant occupational or environmental exposure history. Early diagnosis through comprehensive serological and molecular testing, followed by prompt initiation of evidence-based antibiotic protocols, can substantially improve clinical outcomes. This report underscores the imperative of stringent occupational safety measures in preventing this debilitating zoonotic infection.