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case_images: Timeline of the patient's relevant tests. (A) Cerebrospinal fluid results during the course of the disease; (B) Results of brucella antibody detection during the course of disease; (C) Metacap sequencing.
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case_images: The results of the brucellosis antibody test conducted at the local hospital indicated a positive result for the brucellosis tiger red plate agglutination test (+) and a brucellosis test tube agglutination test result of 1:200 (++++) ( Figure 1B ). Gait and posture: flat car thrust; The serological examination during the course of the disease is shown in the figure ( Table 1 ). Cerebrospinal fluid (CSF) results showed abnormalities ( Figure 1A ), and myelitis was diagnosed and transferred to the Department of Neurology for continued treatment. On the 9th and 16th day of admission, the cerebrospinal fluid reexamination ( Figure 1A ) revealed a decrease in the white blood cell count and protein content, the patient gradually got out of bed from the paraplegic state, the reaction ability was enhanced, the mood was improved, the stool was still not fully controlled, and the urine changed from incontinence to self-control. The specimens were sent to Zhengzhou Jinyu Clinical Laboratory for pathogen detection using MetaCAP , which confirmed our diagnosis ( Figure 1C ). According to our regular follow-up, the patient improved two cerebrospinal fluid examinations ( Figure 1A ) after returning to the local hospital for treatment. The patient revisited our hospital's infection department for re-examination of the cerebrospinal fluid, but no significant abnormalities were detected ( Figure 1A ).
case_images: Disease progression chart. Therapeutic: (1)Doxycycline; (2)Cefixime dispersible tablet; (3)Ciprofloxacin ; (4)Moxifloxacin; (5)Rifampicin; (6)Amikacin; (7)Ceftriaxone sodium for injection; (8)Dexamethasone sodium phosphate injection; (9)Compound brain peptide ganglianzhi injection; (10)Mecobalamine; (11)Vitamin B1 tablet.
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case_images: The patient's medical nature was poor, and his condition had been aggravated several times since his diagnosis until he came to our hospital this time, and he was treated in different hospitals ( Figure 2 ). Two weeks ago, the patient suddenly experienced weakness in both lower limbs, which gradually worsened, accompanied by numbness of the cheek and around the mouth, askew of mouth, choking cough of drinking water, incontinence of stool and urine (continuous alternation of constipation and diarrhea), decreased tactile sensation of both lower limbs, no fall and loss of unconsciousness. In this case, the patient's head MRI ( Figure 2 ) revealed multiple abnormal signal shadows, indicating potential inflammatory demyelination associated with neurobrucellosis.
case_images: Head MRI shows: 1. Multiple abnormal signal shadows in the bilateral semioval center, bilateral lateral ventricular periphery, bilateral temporal lobes, bilateral insular cortex, and pons. There was no significant change in the result of reexamination.
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case_images: Upon revisiting the local hospital, the head MRI revealed multiple abnormal signals in various regions, including the bilateral semioval center, bilateral periventricular area, bilateral temporal lobe, bilateral insular cortex, and pons ( Figure 3 ).
case_images: Cervical MRI (A, C): T2 signals on the right side of the spinal cord were enhanced at the C3/4 level. C5/6 disc herniation with left posterior hernia and increased spinal T2 signal at corresponding levels. After treatment, C3/4 reinforcement was significantly reduced, but C5/6 did not change (B, D).
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case_images: T2 signal intensity in the right part of the spinal cord. C5/6 intervertebral disc bulging and protrusion, corresponding to spinal cord degeneration  Figure 4C . The limb electromyography, visual evoked potential, and auditory evoked potential tests revealed the following findings:1.Peripheral neurogenic damage in both lower extremities with involvement of sensory and motor fibers. 2. Figures 4A, B ). For C5/6 disc herniation, corresponding to spinal cord degeneration, no significant changes were observed ( Figures 4C, D ). However, after treatment, the extent of the lesions significantly reduced ( Figures 4A, B ).