{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:53:50Z","timestamp":1781484830107,"version":"3.54.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0012824","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000}}],"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Neurobrucellosis is a rare manifestation of brucella infection, which would be life-threatening and result in multiple disabilities. Brucellosis commonly manifests with fever, arthralgia, and myalgia. Moreover, most patients with Neurobrucellosis present with significant lesions in the brain, spinal cord, or vertebral column; some cases show no lesions in their magnetic resonance imaging (MRI). The present case is a 32-year-old rural man with suspicious contact with animals at his work who was presented with ataxia, paraplegia, and urine-fecal incontinence without typical symptoms of brucellosis. Broad-spectrum diagnostic methods for neurobrucellosis were employed, including the Wright and 2-mercaptoethanol (2-ME) tests on plasma and brain, as well as spinal MRI. However, no significant pathologies were found in the brain or spinal imaging that could explain the patient\u2019s clinical condition, and the Wright and 2-ME tests were negative. Also, despite a comprehensive approach to different viral, bacterial, autoimmune, systemic, metabolic, and organic etiologies, the symptoms of the patient got worse, and he experienced depression, sensorineural hearing loss (SNHL), and visual impairment in the following months. Eventually, the patient\u2019s cerebrospinal fluid specimen Wright &amp; 2-ME tests became positive, and a standard antibiotic regimen, including doxycycline, rifampin, and ceftriaxone, was administered for several months. In his last follow-up two years later, all neurological and psychological issues had disappeared except mild ataxia and hearing impairment. Hence, the prozone phenomenon should be considered in the false-negative Wright tests in endemic regions for brucellosis.<\/jats:p>","DOI":"10.1371\/journal.pntd.0012824","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T17:41:25Z","timestamp":1753810885000},"page":"e0012824","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["A rare case report of neuro-brucellosis with concurrence of depression, visual impairment, bilateral sensorineural hearing loss, and paraplegia"],"prefix":"10.1371","volume":"19","author":[{"given":"Hossein","family":"Pourmontaseri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maziyar","family":"Rismani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbad","family":"Karami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1245-0896","authenticated-orcid":true,"given":"Zahra","family":"Montaseri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Azmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedighe","family":"Hooshmandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"issue":"22","key":"pntd.0012824.ref001","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1056\/NEJMra050570","article-title":"Brucellosis","volume":"352","author":"G Pappas","year":"2005","journal-title":"N Engl J Med"},{"key":"pntd.0012824.ref002","volume-title":"Brucellosis in humans and animals","author":"MJ Corbel","year":"2006"},{"issue":"1","key":"pntd.0012824.ref003","doi-asserted-by":"crossref","first-page":"2290839","DOI":"10.1080\/22221751.2023.2290839","article-title":"Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis","volume":"13","author":"Z Liu","year":"2024","journal-title":"Emerg Microbes Infect"},{"key":"pntd.0012824.ref004","volume-title":"The prokaryotes: a handbook on the biology of bacteria","author":"M Dworkin","year":"2006"},{"issue":"6","key":"pntd.0012824.ref005","doi-asserted-by":"crossref","first-page":"408","DOI":"10.5455\/msm.2016.28.408-411","article-title":"Clinical manifestations in 82 neurobrucellosis patients from Kosovo","volume":"28","author":"S Dreshaj","year":"2016","journal-title":"Mater Sociomed"},{"issue":"5","key":"pntd.0012824.ref006","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s15010-016-0901-3","article-title":"Cranial imaging findings in neurobrucellosis: results of Istanbul-3 study","volume":"44","author":"H Erdem","year":"2016","journal-title":"Infection"},{"issue":"5","key":"pntd.0012824.ref007","article-title":"Laboratory features of patients with brucellosis and its association with titer of Wright agglutination test","volume":"17","author":"A Farazi","year":"2014","journal-title":"Iran South Med J"},{"issue":"1","key":"pntd.0012824.ref008","first-page":"17","article-title":"Epidemiology of brucellosis in the North and North-West Iran","volume":"11","author":"R Pakzad","year":"2016","journal-title":"Param Sci Mil Health"},{"key":"pntd.0012824.ref009","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3389\/fvets.2018.00147","article-title":"Brucellosis control in Malta and Serbia: a one health evaluation","volume":"5","author":"SC Buttigieg","year":"2018","journal-title":"Front Vet Sci"},{"key":"pntd.0012824.ref010","volume-title":"Principles and practice of infectious diseases","author":"RG Douglas","year":"1985"},{"issue":"2","key":"pntd.0012824.ref011","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/0028-3886.32790","article-title":"Extensive meningoencephalitis, retrobulbar neuritis, and pulmonary involvement in a patient of neurobrucellosis","volume":"55","author":"P Vinod","year":"2007","journal-title":"Neurology India"},{"issue":"4","key":"pntd.0012824.ref012","first-page":"385","article-title":"Unusual presentation of neurobrucellosis in Jeddah, Kingdom of Saudi Arabia","volume":"26","author":"MA Kanjo","year":"2021","journal-title":"Neurosci J"},{"issue":"03","key":"pntd.0012824.ref013","doi-asserted-by":"crossref","first-page":"110","DOI":"10.5799\/ahinjs.02.2011.03.0025","article-title":"The false sero-negativity of brucella standard agglutination test: Prozone phenomenon","volume":"1","author":"H Karsen","year":"2011","journal-title":"J Microbiol Infect Dis"},{"issue":"5","key":"pntd.0012824.ref014","doi-asserted-by":"crossref","first-page":"412","DOI":"10.4103\/0256-4947.67084","article-title":"A rare case of seronegative neurobrucellosis","volume":"30","author":"S Tekin-Koruk","year":"2010","journal-title":"Ann Saudi Med"},{"key":"pntd.0012824.ref015","first-page":"1","article-title":"Neurobrucellosis presenting with motor damage or hearing loss, and use of steroids are associated with a higher risk of sequelae or relapse: a systematic review of individual participant data","author":"C Fusetti","year":"2024","journal-title":"Neurol Sci"},{"issue":"9","key":"pntd.0012824.ref016","article-title":"Neurobrucellosis complicated by sensorineural hearing loss: a case report","volume":"14","author":"B Mirza","year":"2022","journal-title":"Cureus"},{"issue":"1","key":"pntd.0012824.ref017","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s13256-023-03836-x","article-title":"Hearing loss: an unusual presentation of neurobrucellosis: a case report","volume":"17","author":"PK Sah","year":"2023","journal-title":"J Med Case Rep"},{"issue":"1","key":"pntd.0012824.ref018","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s41182-022-00472-x","article-title":"Neurobrucellosis: report of 54 cases","volume":"50","author":"H Naderi","year":"2022","journal-title":"Trop Med Health"},{"key":"pntd.0012824.ref019","first-page":"1","article-title":"Neurobrucellosis: a case report from Himachal Pradesh, India, and review of the literature","volume":"2016","author":"S Raina","year":"2016","journal-title":"Case Rep Infect Dis"},{"issue":"4","key":"pntd.0012824.ref020","doi-asserted-by":"crossref","first-page":"62","DOI":"10.31157\/archneurosciencesmex.v22i4.169","article-title":"Neurobrucellosis: magnetic resonance findings","volume":"22","author":"J G\u00f3mez-Ru\u00edz","year":"2018","journal-title":"Arch Neurocienc"},{"issue":"1","key":"pntd.0012824.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jrid.2018.02.001","article-title":"MRI features and categories of neurobrucellosis: a pooled review","volume":"5","author":"C Jiang","year":"2018","journal-title":"Radiol Infect Dis"},{"issue":"1","key":"pntd.0012824.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3844\/ajidsp.2012.1.4","article-title":"Comparing of routine 2 mercaptoethanol (2ME) and coombs wright plus 2ME","volume":"8","author":"KH Bagheri","year":"2012","journal-title":"Am J Infect Dis"},{"key":"pntd.0012824.ref023","doi-asserted-by":"crossref","first-page":"1259479","DOI":"10.3389\/fmicb.2023.1259479","article-title":"Epidemiology, clinical manifestations, and laboratory findings of 1,590 human brucellosis cases in Ningxia, China","volume":"14","author":"B Liu","year":"2023","journal-title":"Front Microbiol"},{"issue":"5","key":"pntd.0012824.ref024","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1128\/CDLI.6.5.756-759.1999","article-title":"Detection of antibodies to Brucella cytoplasmic proteins in the cerebrospinal fluid of patients with neurobrucellosis","volume":"6","author":"PC Baldi","year":"1999","journal-title":"Clin Diagn Lab Immunol"},{"issue":"3","key":"pntd.0012824.ref025","doi-asserted-by":"crossref","DOI":"10.1111\/iwj.14788","article-title":"Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: a narrative review","volume":"21","author":"M Dehghani","year":"2024","journal-title":"Int Wound J"},{"key":"pntd.0012824.ref026","doi-asserted-by":"crossref","first-page":"817229","DOI":"10.3389\/fneur.2022.817229","article-title":"Do muscle changes contribute to the neurological disorder in spastic paresis?","volume":"13","author":"M Pradines","year":"2022","journal-title":"Front Neurol"},{"key":"pntd.0012824.ref027","doi-asserted-by":"crossref","first-page":"39","DOI":"10.31640\/JVD.7-8.2020(5)","article-title":"Diabetic polyneuropathy: features of the clinical picture and electroneuromyographic parameters in the presence of comorbidity","volume":"2020","author":"V Dubynetska","year":"2020","journal-title":"Lik Sprava"},{"key":"pntd.0012824.ref028","doi-asserted-by":"crossref","first-page":"577668","DOI":"10.1016\/j.jneuroim.2021.577668","article-title":"Virus discovery in chronic inflammatory demyelinating polyneuropathy","volume":"358","author":"G van Lieverloo","year":"2021","journal-title":"J Neuroimmunol"},{"issue":"4","key":"pntd.0012824.ref029","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5114\/reum.2021.108686","article-title":"Systemic lupus erythematosus and critical illness polyneuropathy","volume":"59","author":"M Katkowska","year":"2021","journal-title":"Reumatologia\/Rheumatology"},{"key":"pntd.0012824.ref030","first-page":"587","article-title":"Autoimmune polyneuropathies.","volume-title":"Handbook of clinical neurology, Vol 195","author":"R Naum","year":"2023"},{"key":"pntd.0012824.ref031","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvab048.1875","article-title":"Acute inflammatory demyelinating polyneuropathy (AIDP) masked by autoimmune thyroiditis","volume":"5","author":"S Wirtshafter","year":"2021","journal-title":"J Endocr Soc"},{"issue":"102","key":"pntd.0012824.ref032","first-page":"945","article-title":"Clinical profile of uremic polyneuropathy in chronic kidney disease patients","volume":"24","author":"P Aradhey","year":"2020","journal-title":"Med Sci"},{"issue":"1","key":"pntd.0012824.ref033","doi-asserted-by":"crossref","first-page":"25","DOI":"10.14740\/jnr542","article-title":"Clinical features of chronic inflammatory demyelinating polyneuropathy with autoimmune hepatitis","volume":"10","author":"Y Bao","year":"2020","journal-title":"J Neurol Res"},{"issue":"3","key":"pntd.0012824.ref034","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1128\/AAC.05974-11","article-title":"Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study","volume":"56","author":"H Erdem","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"pntd.0012824.ref035","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.12659\/MSM.897947","article-title":"Treatment efficacy and risk factors of neurobrucellosis","volume":"22","author":"S Zhao","year":"2016","journal-title":"Med Sci Monit"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0012824","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T17:54:51Z","timestamp":1754589291000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0012824"}},"subtitle":[],"editor":[{"given":"David J.","family":"Diemert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0012824","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0012824","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,29]]}}}