Pediatric neurobrucellosis and atypical Guillain-Barré syndrome: an intriguing case unveiled

Brucellosis, a chronic zoonotic disease with a significant global burden, particularly in endemic areas, can also present as neurobrucellosis, a rare complication.We report a case of polyradiculoneuropathy in a pediatric patient resulting from this uncommon presentation.A 5-year-old girl presented with progressive asymmetric lower limb weakness for two weeks that progressed to a loss of ambulation in four weeks.She also had flu-like symptoms and persistent highgrade fever.Her history was notable for ingesting raw milk before the onset of fever.Initial examination revealed meningismus signs and fever.She had bilateral weak hip flexion graded 4/5 on the Medical Research Council (MRC) scale, weak right and left knee flexion (3/5 and 4/5, respectively), and weak right ankle dorsiflexion (4/5).She also had diminished reflexes throughout.The patient exhibited a clinical picture resembling Guillain-Barré Syndrome (GBS) after admission as her weakness progressed.Cerebrospinal fluid (CSF) analysis revealed no cell counts, elevated protein levels (1545 mg/dL), and normal glucose levels (3.34 mmol/L).Blood and CSF cultures were negative, but the serum antibody titer was elevated at 1:1280 against Brucella melitensis and Brucella abortus species.Lumbosacral MRI showed diffuse enhancement of the lower nerve roots.A nerve conduction study (NCS) demonstrated axonal and demyelinating polyradiculoneuropathy.The patient regained her strength three months after presentation, following a course of antibiotics.When evaluating patients with atypical manifestations resembling GBS, brucellosis should be considered an important differential diagnosis in endemic areas.