Concurrent neurobrucellosis and central nervous system aspergillosis in an immunocompetent host: a case report

INTRODUCTION: Neurological infections often present with diverse symptoms, making coinfections particularly challenging. This study highlights an unusual case of dual coinfections caused by brucellosis and aspergillosis, emphasizing the complexity and severity of such infections. CASE PRESENTATION: A 27-year-old Syrian male patient with a history of adequately treated systemic brucellosis 3 years prior, presented with a 6-month history of progressive bilateral hearing loss, lower limb weakness, and intermittent incontinence. Neurological examination revealed bilateral sensorineural hearing loss and lower limb proprioceptive loss. Diagnostic workup confirmed neurobrucellosis via elevated Brucella immunoglobulin G antibodies in the cerebrospinal fluid, and neuroaspergillosis by cerebrospinal fluid culture growing Aspergillus fumigatus. Initial treatment for neurobrucellosis with ceftriaxone, doxycycline, rifampicin, and levofloxacin was adjusted upon fungal diagnosis to include voriconazole and trimethoprim-sulfamethoxazole. The patient subsequently underwent surgical excision of a concomitant T5-T9 arachnoid cyst. After 4 months of antimicrobial and 2 months of antifungal therapy, follow-up revealed significant clinical improvement in limb strength and incontinence, along with normalization of cerebrospinal fluid parameters. CONCLUSION: This case highlights the diagnostic challenges and rarity of coexisting neurobrucellosis and Aspergillus infection, a combination not previously reported in medical literature. Both conditions are uncommon in the central nervous system and typically affect immunocompromised patients, making diagnosis difficult due to nonspecific symptoms and broad differential diagnoses. The successful treatment of this unique case underscores the need for further research into managing such unusual co-infections.