A 17-year-old man, living in a metropolis in the south of the country, with no medical history, was admitted to the emergency ward with complaints of a chronic headache evolving for 9 months with some episodes of vomiting and intermittent fever. There had no visual deficit or limb weakness or balance impairment. He received empiric antibiotic in fever episodes without real improvement. On examination, the patient was conscious, febrile (39  C) with stiff neck without limb deficit but some brisk reflexes on the lower limbs. Fundus examination was normal. Cerebrospinal fluid (CSF) was at high pressure and showed 90 cells (neutrophils 56%, lymphocytes 44%), proteins 4,11 g/l, glucose 3.06 mg/dl (blood glucose: 108.1 mg/dl).
Gram stain was normal. Soluble antigens screen using Wellcozyme Oxoid  eliminated other pathogens of meningitis. CSF GeneXpert investigation was negative excluding mycobacterium tuberculosis complex.
CSF culture in blood medium grew brucella melitensis while blood culture (BACTEC  960 BC system, Becton-Dickinson) remained negative after 3 weeks of incubation.
Blood formula showed haemoglobin of 10 g/dl with normal WBC and platelets, sedimentation rate, electrolytes, kidney and liver testing. CRP was mildly positive at 13.1 mg/l
Rose Bengal test (Brucellosis slide BioMerieux  France) was positive in the serum and CSF. CSF Wright test (brucella wright biorad , France) was positive with a titer of 640. Other serological tests for syphilis, human immunodeficiency virus (HIV), hepatitis B and C virus and Borrelia were negative.
Magnetic resonance imaging (MRI) showed evocative signs of a leptomeningitis with meninges thickening especially in posterior cerebral fossa and spinal cone.
Thoraco-abdominal computed tomography (CT-Scan) showed lymph nodes in the stomachic coronary chains and the coeco-colo-appendicular regions, and discrete anterior vertebral collapse of the D11 without instability signs.
Electroencephalography showed slow spikes in the left temporal lobe. Ophthalmological examination was normal.
We concluded to neurobrucellosis diagnosis. The patient was given rifampicin 900 mg/d, doxycycline 200 mg/d for 3months. Clinical and biological outcome was favourable.