Acute Brucellosis with a Guillain-Barre Syndrome-Like Presentation: A Case Report and Literature Review

Brucellosis is a zoonotic disease that can affect the central and peripheral nervous system and it has variable neurological manifestation. However, brucellosis infection that presents with acute peripheral neuropathy mimicking Guillain-Barre syndrome (GBS) is rarely reported in the literature. We report a 56-year-old man who was initially diagnosed with GBS, and then he was confirmed to have acute infection. We also did a systematic literature review to study the natural history and management of previously reported cases of brucellosis that presented with manifestations consistent with GBS. We found 19 (including our patient) cases of brucellosis that presented with GBS-like manifestations. The age range was 9-62 years. Eight (42.1%) patients had a history of fever. Seven (36.8%) patients had no constitutional symptoms. Five (26.3%) patients had splenomegaly. serological tests were positive in all patients, while blood culture was positive in three (37.5%) out of eight patients. Albuminocytological dissociation was present in nine (64.3%) out of 14 patients. Nerve conduction studies and electromyography were consistent with demyelination polyneuropathy in eight (42.1%) patients, with axonal polyneuropathy in six (31.6) patients, and with mixed axonal and demyelinating polyneuropathy in one (5.3%) patient. Spine MRI showed root enhancement in three (42.9%) patients. In regions endemic with brucellosis, acute peripheral neuropathy presentation may warrant investigations for infection.