Indian doctors report rare case of Disseminated Cysticercosis

Written by Hina Zahid Published On 2019-03-31T18:00:58+05:30 | Updated On 31 March 2019 6:00 PM IST

Drs. Nishanth Dev and S. Zafar Abbas of the ESIC Medical College and Hospital in Faridabad, Haryana, India have reported a rare case of Disseminated cysticercosis. The case has appeared in the NEJM.

Disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread out through the whole body. Widespread dissemination of cysticerci throughout the human body was reported as early as 1912 by British Army medical officers stationed in India. Currently, fewer than 50 cases have been reported worldwide, the majority being form India.

Neurocysticercosis is infection of the central nervous system by tapeworm and is a leading cause of epilepsy worldwide. It is a preventable parasitic infection of the central nervous system and is caused by the pork tapeworm Taenia solium. Humans become infected after consuming undercooked food, particularly pork, or water contaminated with tapeworm eggs, or through poor hygiene practices. The larvae crawl out of the eggs and into muscle and brain tissues, where they form cysts.

According to history, a 18-year-old man presented to the emergency department with generalized tonic–clonic seizures. His parents reported that he had been having pain in the right groin for 1 week. On physical examination, the patient was confused. He had swelling over the right eye and tenderness in the right testis.

Magnetic resonance imaging of the head showed numerous well-defined cystic lesions throughout the cerebral cortex and the brain stem and cerebellum that were consistent with neurocysticercosis. Well-defined cysts that contained echogenic nodules were seen on ultrasonography of the eye and the right testis. Western blot analysis and enzyme-linked immunosorbent assay showed positive results for serum cysticercosis IgG antibody.

In the context of high cyst burden, treatment with antiparasitic medications can worsen inflammation and cerebral edema, and in the presence of ocular lesions, inflammation can lead to loss of vision. Therefore, antiparasitic medications were not administered in this case. Despite treatment with dexamethasone and antiepileptic medications, the patient died 2 weeks later.

For more details click on the link: DOI: 10.1056/NEJMicm1810953

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Hina Zahid