A BRUCELLOSIS CASE WITH MACULAR RASH AND PERIPHERAL NEUROPATHY

Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36 years old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L4-5 involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in the blood culture by automated BacT/ALERT 3D system (bioMerieux, USA) and the bacteria was identified as Brucella melitensis by automated VITEK-2 system (bioMerieux, France). Microbiologic diagnosis was confirmed by detection of agglutination with polyvalent and monovalent anti-M Brucella sera. The patient was successfully treated with rifampicin and doxycycline combination for six weeks. The macular rash was recruited leaving a brown pigmentation in the first week of treatment, whereas the neurologic signs and symptoms disappeared at the end of the first month. Brucella infection should be considered in the differential diagnosis of skin rash and neurologic disorders especially in endemic areas such as Turkey.