Clinical features of Brucella meningitis combined with anti-N-methyl-D-aspartate receptor encephalitis(report of one case) / 临床神经病学杂志

ABSTRACT

Objective To investigate the clinical features of Brucella meningitis combined with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis.Methods The clinical data of one patient diagnosed by the Department of Neurology of Nanjing Second Hospital in May 2022 with brucella meningitis combined with anti-NMDAR encephalitis were reported,and its clinical characteristics were summarized and analyzed through literature search.Results The patient was a 33-year-old man with headache,vomiting,weakness in both lower extremities,and fever 1 week later.Brain MRI showed abnormal signals in the deep white matter of the bilateral frontal lobes,and mild enhancement of the basal ganglia and pia mater.CSF suggested an increase in nucleated cells,mainly monocytes,increased protein,and decreased glucose.CSF culture showed Brucella,Brucella IgG antibody(+),Brucellosis tiger red plate agglutination test(+),test tube agglutination test was 1∶25,and temperature decreased after anti-brucella treatment.Patients presented with unresponsiveness,cognitive decline,and speech impairment in the 22nd day of the course of the disease,CSF pathogenic microorganism metagenomic testing suggested Brucella malta,and CSF autoimmune antibodies suggested moderate positivity for antiglutamate receptor(NMDAR type).Symptoms improved with high-dose shock hormone therapy.Conclusions CSF etiology metagenomic testing can improve the diagnosis rate of Brucella meningitis.Brucella may be used as a predisposing factor for anti-NMDAR encephalitis,when the patient's condition is recurrent,and cognitive decline,speech disorders and other symptoms,it is necessary to be alert to the possibility of promoting anti-NMDAR encephalitis,and relevant antibody detection should be improved in time to start immunotherapy as soon as possible.