Unusual Presentation of Neurobrucellosis Presenting with the Features of Parkinsonism: Two Case Reports and a Review of the Literature

Moneera Aldraihem^1*Thamer Alhowaish²Yazeed Alotaibi³Mohammed Alshareet¹Abdulrahman A Alrasheed³Mazen Alamr¹Omar A Alsinaidi¹Abdulrahman S Ali¹Hisham Aldhukair¹

• ¹King Fahad Medical City, Riyadh, Saudi Arabia
• ²King Abdulaziz Medical City in Riyadh, Riyadh, Saudi Arabia
• ³Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Brucellosis, a zoonotic disease caused by Brucella species, remains endemic in regions such as Saudi Arabia. While neurobrucellosis is a serious complication, its presentation with parkinsonian features and psychiatric manifestations is exceedingly rare, with only six such cases reported in the literature. These case reports add to the limited data on atypical presentations of neurobrucellosis.To describe two cases of neurobrucellosis presenting with Parkinsonism-like symptoms and psychiatric manifestations, highlighting the diagnostic challenges and therapeutic responses in a rare manifestation of this zoonotic infection.We report two male patients from Saudi Arabia, aged 75 and 26, diagnosed with neurobrucellosis based on high Brucella titers and cerebrospinal fluid polymerase chain reaction (CSF PCR) results. Both patients presented with Parkinsonism-like symptoms, including tremors, rigidity, and bradykinesia, alongside significant psychiatric disturbances such as hallucinations and cognitive impairment. Brain magnetic resonance imaging (MRI) in both cases revealed abnormalities consistent with meningoencephalitis. Both patients received a combination of antibiotics (doxycycline, rifampicin, and sulfamethoxazole-trimethoprim) and corticosteroids to manage inflammation.