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Brucellosis mimicking herpes simplex virus encephalitis.
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2020-01-01 , DOI: 10.1016/s1473-3099(19)30553-5 Ashok K Pannu 1 , Atul Saroch 1 , Navneet Sharma 1 , Vikas Bhatia 2
The Lancet Infectious Diseases ( IF 36.4 ) Pub Date : 2020-01-01 , DOI: 10.1016/s1473-3099(19)30553-5 Ashok K Pannu 1 , Atul Saroch 1 , Navneet Sharma 1 , Vikas Bhatia 2
Affiliation
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A 15-year-old boy was admitted to the medical emergency centre of the Postgraduate Institute of Medical Education and Research Chandigarh (India) with remittent low-grade fever, backache of low intensity for 2 months, and altered sensorium for 1 day. On examination, he was conscious but drowsy. His vital signs were stable. Neurological examination did not reveal neck rigidity or cranial nerve abnormalities. Analysis of cerebrospinal fluid showed 12 white blood cells per μL (60% lymphocytes), protein 278 mg/dL, glucose 50 mg/dL, with negative test results for herpes simplex virus by PCR and Mycobacterium tuberculosis by nucleic-acid amplification test. Brain MRI revealed T2-weighted fluid-attenuated inversion recovery signal hyperintensity in the left temporal lobe ( ) with diffusion restriction, suggesting focal encephalitis. MRI of the spinal cord showed a well defined peripherally enhancing lesion, suggesting granuloma in the D10 vertebra with normal intervertebral discs ( ). The blood culture subsequently grew Brucella species. The patient lived rurally and had a history of feeding cows. He was treated with rifampicin (450 mg once daily) and doxycycline (100 mg twice daily), both given orally, for 6 months with intramuscular streptomycin (750 mg once daily) for the first 3 weeks. At follow-up at 6 months, the patient was asymptomatic and blood cultures were sterile. A repeat MRI after 3 months showed disappearance of the temporal lobe T2-hyperintensity and reduction in the size of the D10 lesion.
中文翻译：
布鲁氏菌病模仿单纯疱疹病毒性脑炎。
一名15岁男孩因低度发烧，低强度背痛2个月，感觉觉改变1天，被送往印度昌迪加尔医学研究生教育研究院的医学急诊中心。经检查，他有意识但昏昏欲睡。他的生命体征稳定。神经科检查未发现颈部僵硬或颅神经异常。脑脊液分析显示每μL有12个白细胞（60％淋巴细胞），蛋白质278 mg / dL，葡萄糖50 mg / dL，PCR和结核分枝杆菌对单纯疱疹病毒呈阴性结果通过核酸扩增试验。脑MRI显示左侧颞叶（）具有弥散受限的T2加权液体衰减倒置恢复信号高强度，提示局灶性脑炎。脊髓的MRI表现出明确的周围增强病变，提示D10椎骨中有正常椎间盘的肉芽肿（）。血培养随后发展为布鲁氏菌物种。该患者生活在农村，有饲养牛的病史。在开始的三周内，他均接受了利福平（每天一次450毫克）和强力霉素（每天两次100毫克）的口服口服肌内链霉素（每天一次750毫克）治疗6个月。在6个月的随访中，患者无症状，血液培养无菌。3个月后再次进行MRI检查，显示颞叶T2高强度消失，D10病变的大小减小。
更新日期：2019-12-25
中文翻译：
布鲁氏菌病模仿单纯疱疹病毒性脑炎。
一名15岁男孩因低度发烧，低强度背痛2个月，感觉觉改变1天，被送往印度昌迪加尔医学研究生教育研究院的医学急诊中心。经检查，他有意识但昏昏欲睡。他的生命体征稳定。神经科检查未发现颈部僵硬或颅神经异常。脑脊液分析显示每μL有12个白细胞（60％淋巴细胞），蛋白质278 mg / dL，葡萄糖50 mg / dL，PCR和结核分枝杆菌对单纯疱疹病毒呈阴性结果通过核酸扩增试验。脑MRI显示左侧颞叶（）具有弥散受限的T2加权液体衰减倒置恢复信号高强度，提示局灶性脑炎。脊髓的MRI表现出明确的周围增强病变，提示D10椎骨中有正常椎间盘的肉芽肿（）。血培养随后发展为布鲁氏菌物种。该患者生活在农村，有饲养牛的病史。在开始的三周内，他均接受了利福平（每天一次450毫克）和强力霉素（每天两次100毫克）的口服口服肌内链霉素（每天一次750毫克）治疗6个月。在6个月的随访中，患者无症状，血液培养无菌。3个月后再次进行MRI检查，显示颞叶T2高强度消失，D10病变的大小减小。
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