Neurocysticercosis presented as a solitary cystic parenchymal lesion mimicking primary brain tumor: A case report.
IDCases 2020;
22:e01004. [PMID:
33204635 PMCID:
PMC7649621 DOI:
10.1016/j.idcr.2020.e01004]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Neurocysticercosis (NCC) is an endemic zoonotic infection in pork-eating region, including Bali.
Despite its high prevalence, diagnosing an NCC can be challenging due to the protean clinical manifestations.
Herein we describe an NCC case mistakenly diagnosed as a brain tumor, only later that we discovered the active larvae of Taenia solium, the pathogen which causes NCC.
A high index of suspicion towards NCC should always be maintained, particularly among patients originated from endemic area.
Appropriate treatment with anthelminthic may result in full disease resolution, thus precluding unnecessary invasive approach.
Introduction
Neurocysticercosis (NCC) is an infection of the central nervous system by the larval stage of pork tapeworm (Taenia solium/T. solium). Diagnosing NCC can be challenging, particularly among those who reside in areas with rare occurrence of NCC and atypical manifestation such as a solitary parenchymal lesion. We treated a patient whose initially was diagnosed with brain abcess and later, brain tumor, only finally revealed to be an NCC case.
Case report
A 25-year old male suffered from multiple focal-to-bilateral tonic clonic seizures, was initially diagnosed as brain abscess. He was given antibiotics and anti-seizure medication but the seizure relapsed with a typical semiology. Physical examination demonstrated grade I papilledema, grade 4+ hemiparesis, and headache of vascular origin. Patient was suspected to have oligodendroglioma after underwent head MRI examination and subsequent tumor resection was performed. Pathological anatomy evaluation demonstrated multiple cystic segments containing larva of tapeworm, supporting a diagnosis of active NCC infection. After 14-day course of antheminthic treatment and resumed AED, patient was seizure-free and NCC was not found upon follow-up CT scan.
Conclusion
NCC, with respect to clinical and radiological manifestations, can be protean. A high index of suspicion towards NCC should always be maintained, particularly among patients originated from endemic area. Appropriate treatment with anthelminthic may result in full disease resolution, thus precluding unnecessary invasive approach.
Collapse