Neurobrucellosis Manifesting as Secondary Hemiparkinsonism in a Veterinary Technician: An Occupational Health Case Report

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Background: Neurobrucellosis is a rare but serious complication of brucellosis, affecting 2-10% of systemic cases. Movement disorders, particularly parkinsonian features, represent an unusual manifestation that is poorly documented in medical literature. Case Presentation: We report a 51-year-old male veterinary technician who developed progressive neurological symptoms over two years, beginning with fine tremor in his right upper limb and evolving to secondary right hemiparkinsonism with functional impairment. The patient presented with systemic manifestations including fever, weight loss, arthralgia, and headaches. Neuroimaging revealed hyperintensity in the right inferior cerebellar peduncle with post-contrast enhancement. Laboratory investigations confirmed neurobrucellosis through positive Rose Bengal test, elevated Brucella antibodies in serum and cerebrospinal fluid (CSF), and positive PCR for Brucella DNA in CSF. The patient was treated with combination antibiotic therapy (doxycycline, rifampicin, and ceftriaxone) for six months, plus symptomatic treatment with levodopa/carbidopa. Clinical improvement was achieved with resolution of systemic symptoms and significant improvement in neurological manifestations, though mild residual parkinsonian features persisted at 24 month follow-up. Conclusions: This case highlights the importance of considering neurobrucellosis in the differential diagnosis of movement disorders, particularly in patients with occupational exposure to animals. Early diagnosis and appropriate treatment can lead to significant clinical improvement, though some neurological sequelae may persist. Enhanced occupational safety measures are crucial for preventing such complications in high-risk populations.

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