Rare case of Disseminated neurocysticercosis presenting with bilateral papilledema: a report

Dr Ruchi Shrestha at Department of Ophthalmology, Reiyukai Eiko Masunaga Eye Hospital, Kavrepalanchok District, Nepal and colleagues have reported a rare case of Disseminated neurocysticercosis. The case has appeared in the Journal of Medical Case Reports.

Neurocysticercosis is the most common parasitic infection of the central nervous system. A disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread out through the whole body.In all fewer than 75 cases of disseminated cysticercosis have been reported in the world.

A 22-year-old Brahmin man presented with complaints of gradual, painless, progressive loss of vision in both eyes for 1 month. It was associated with complaints of headache and dizziness for 1 month. He had a history of multiple painless swellings over his body for the past 1 year. Multiple swellings were present on his face, mandibular area, elbow, arm, and abdomen. His headache was intense on awakening and bending down position. He had a history of fever for 2 days after intake of anti-filariasis medication 1 month back. There was no history of vomiting, unconsciousness, seizures, or change in behavior. He had a history of using tablet amitriptyline 75 mg before sleep for headache for the past 15 days. He was a plumber by occupation. He did not smoke tobacco or drink alcohol; he was not a vegetarian by diet and had a history of eating wild pork meat. There was no significant history of similar illness in his family. There was no significant social and environmental history. On examination, he was healthy and well oriented to time, place, and person. His visual acuity was 6/12 in both eyes. Intraocular pressure was 12 mmHg in both eyes. He had multiple small pea-sized nodules which were soft, mobile, non-tender, and well defined; each nodule was approximately 2 × 2 cm. There were no signs of inflammation on his face, mandibular area, elbow, arm, and abdomen (Fig. 1).

His vital signs and systemic examination were normal. He had no neurological deficit. The pupillary reaction was sluggish in both eyes, otherwise, the anterior segment was unremarkable. The posterior segment revealed papilledema in both eyes in the form of blurred, elevated disc margin and tortuous dilated vessels. Parapapillary hemorrhage was present in his left eye. The macula was healthy with a good foveal reflex (Fig. 2).

Blood reports were hemoglobin 11.5 gm%, neutrophils (N) 55%, lymphocytes (L) 22%, eosinophils (E) 12%, monocytes (M) 1%, erythrocyte sedimentation rate (ESR) 30 mm/first hour, total leukocyte count (TLC) 7800 cells/mm3, and random blood sugar (RBS) 80 mg%. His serology was negative. His urine routine microscopy was normal. Stool routine microscopy showed absence of parasites. A CT scan showed multiple calcified lesions with scolex in cerebellum and brain parenchyma, with multiple sites of edema on left side of parietal area suggestive of neurocysticercosis (Fig. 3).

A physician consultation was done and he was treated with intravenous injection of dexamethasone and the dose was tapered every 3 days: 4 mg dexamethasone intravenously administered thrice daily for 3 days, 2 mg intravenously administered bi-daily for 3 days, and 2 mg intravenously administered once daily for 3 days. Tablet albendazole 400 mg was prescribed bi-daily for 1 month and tablet valproic acid was prescribed 300 mg bi-daily for 1 month. Unfortunately, we lost the follow-up of our patient.

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   Disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread throughout the body.

   
   


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   It is important to recognise disseminated cysticercosis clinically and to perform appropriate radiological investigations, because this condition requires an appropriate therapy.