以渐进性视力下降为主要表现的神经型布氏杆菌病1例报道并文献复习

Neurotypic brucellosis with progressive visual impairment as its main manifestation:a case report and literature review

目的分析以渐进性视力下降为主要表现的神经型布氏杆菌病患者1例的临床特征、影像学特点和实验室特点。方法回顾性介绍首都医科大学宣武医院神经内科收治的神经型布氏杆菌病患者l例并进行相关文献复习。结果患者中年男性,主因"耳鸣19个月,左眼视力下降9个月,右眼视力下降7个月"入院。养牛多年。神经系统查体视神经、听神经受损及脑膜刺激征阳性。头颅MR提示显著脑膜强化。脑脊液白细胞轻度升高,以单核细胞为主,蛋白增高,葡萄糖正常。脑脊液布氏杆菌凝集试验(++)。治疗予利福平、多西环素和头孢曲松钠三联抗生素,患者部分症状缓解,视力下降无缓解。结论神经型布氏杆菌病表现多样,临床工作者对该类疾病认识不足,误诊率高。如临床症状及影像学检查符合脑膜炎表现,但病因诊断不清时,需排除神经型布氏杆菌病。

Objective To analyze the clinical,imaging and laboratory features of 1 case of neurobrucellosis with progressive visual impairment as the main manifestation. Methods A retrospective review of 1 case of neurobrucellosis admitted to Xuanwu Hospital of Capital Medical University was made. Results The patient was a middle aged male,who was hospitalized because of tinnitus for 19 months,visual acuity of left eye for 9 months and visual acuity of right eye for 7 months. Cattle have been raised for many years. Neurological examination showed positive signs of optic nerve,auditory nerve damage and meningeal irritation. Brain MR showed marked meningeal enhancement. The white blood cells in cerebrospinal fluid increased slightly,mainly monocytes,protein increased,and glucose was normal. Brucella agglutination test in cerebrospinal fluid was positive (+ +). Rifampicin,doxycycline and ceftriaxone sodium were given for treatment. Some of the symptoms were relieved and the visual acuity was not relieved. Conclusion The manifestations of neurobrucellosis are diverse. Clinicians do not know enough about this kind of disease and have a high rate of misdiagnosis. If the clinical symptoms and imaging findings are consistent with the manifestations of meningitis,but the etiological diagnosis is not clear,neurobrucellosis should be excluded.