| Abstract|| |
Cysticercosis is a common tropical disease and a common cause of seizures and neurological morbidity. Neurocysticercosis (NCC) is the most common manifestation of the disease involving the central nervous system (CNS). One of the uncommon manifestations of cysticercosis is its disseminated form. The most commonly affected organs are the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, liver, and occasionally the heart, thyroid, and pancreas but in widespread dissemination it can involve any organ in the body. We report here a case of a 35-year-old-female with disseminated cysticercosis (DCC). She attended our hospital with headache, fever, and symptoms of multiple palpable nodules. After the investigations, she was diagnosed with DCC involving the brain and subcutaneous tissues all over the body. Then she was successfully treated with albendazole and steroids.
Keywords: Disseminated cysticercosis (DCC), human cysticercosis, Taenia solium
|How to cite this article:|
Gonjhu D, Sarkar K, Haldar SN, Pramanik N. A rare case of disseminated cysticercosis. Ann Trop Med Public Health 2015;8:290-2
|How to cite this URL:|
Gonjhu D, Sarkar K, Haldar SN, Pramanik N. A rare case of disseminated cysticercosis. Ann Trop Med Public Health [serial online] 2015 [cited 2020 Sep 19];8:290-2. Available from: http://www.atmph.org/text.asp?2015/8/6/290/162643
| Introduction|| |
Human cysticercosis is caused by the dissemination of Cysticercus cellulosae, a larval form of the tapeworm Taenia solium (T. solium). Humans, the definitive hosts, acquire this infestation by fecal-oral contamination with T. solium eggs from tapeworm carriers. In the small intestine of humans the adult tapeworms are found and the larval forms are found in the skeletal muscle of the intermediate host, the pig. To develop cysticercosis, a human being has to replace the pig in the T. solium life cycle and the eggs must mature within the small intestine of humans as they would do in the pig's intestine. In widespread dissemination cysticerci spread through the intestinal wall and are carried by the blood stream to the muscles, brain, and subcutaneous tissues, leading to clinical manifestations.  Disseminated cysticercosis (DCC) is an uncommon manifestation of this common disease.  The manifestations of DCC are epilepsy, dementia, muscle hypertrophy, subcutaneous and lingual nodules, and a relative absence of focal neurological signs. Only a few (<50) cases of DCC have been reported worldwide, the majority being from India. As cysticerci can involve any organ in the body, their location and size determine the clinical presentation.  Here we report a case of DCC with diffuse involvement of the subcutaneous tissues and brain.
| Case Report|| |
A 35-year-old-female who was a housewife presented with complaints of headache for the last 2 years, low-grade fever, and multiple nodular lesions over various parts of body for 6 months. The headache was insidious in onset, throbbing in nature, mainly on the crown and frontal region and associated with occasional vomiting. She also complained of low-grade fever for 6 months that was not associated with chill and rigor, body ache, or rash. She had also noticed swellings all over her body that had gradually increased in number and size over the last 6 months. There was no history of seizures. She was nonvegetarian but did not consume pork or beef. On clinical examination, multiple nontender cystic nodular lesions of 2-5 cm diameter were found over the scalp, neck [Figure 1], the upper part in both the hands, and tongue [Figure 2]. The results of other systemic examinations were found to be normal.
Investigations revealed hemoglobin of 12.5 gm/dl, total lymphocyte count (TLC) of 10,100, and differential leukocyte count (DLC) of P54%:L36%:E10%. The erythrocyte sedimentation rate (ESR) was 40 mm/h. The result of the routine urine examination was normal and biochemical investigations revealed normal results from the glucose, renal, and liver function tests. Tests for human immunodeficiency syndrome (HIV) using enzyme-linked immunosorbent assay (ELISA) were negative for both HIV 1 and 2. The x-rays of the skull and the extremities were normal. There was no radiographic evidence of calcification in the muscles. Fundus examination was normal. Perimetry was also within normal limits. Magnetic resonance imaging (MRI) scan of the brain showed multiple small cysts in the bilateral cerebellar hemisphere [Figure 3] and in both the cerebral hemispheres, suggested neurocysticercosis (NCC). There was no evidence of hydrocephalus. Biopsy of a subcutaneous swelling was taken from the neck. Cysts poured out as soon as the skin was incised [Figure 4]. Histopathological examination confirmed that the cysts were of C. cellulosae.
The patient was treated with prednisolone 1 mg/kg of body weight 1 week prior to the initiation of albendazole therapy instituted at a dose of 15 mg/kg. By this treatment, significant clinical improvement was seen and the patient was discharged in a favorable condition.
| Discussion|| |
NCC is the most common parasitic infection of the brain and a leading cause of epilepsy in the developing world. But DCC is not a common disease. A widespread disseminated form of cysticercosis was reported as early as 1912 by a British army medical officer in India.  In 1961, a review of 450 cases of cysticercosis by Dixon and Lipscomb reported only one case of dissemination.  Our patient presented with headache, subcutaneous nodules, and lingual nodules and her MRI scan of the brain showed multiple small cysts in a bilateral cerebellar hemisphere and in both the cerebral hemispheres. MRI is more sensitive than computed tomography (CT) as it identifies scolex and live cysts in the cisternal spaces and ventricles and also identifies the response to treatment. , Our patient had fulfilled the diagnostic criteria for human NCC. The presence of one absolute criterion out of three criteria is required for a definitive diagnosis as proposed by Del Brutto et al.,  and this patient had one absolute criterion; histopathological examination confirmed that the cysts were of C. cellulosae. Treatment of DCC is the symptomatic treatment of central nervous system (CNS) lesions using steroids and antiepileptics. Surgical removal of cysts and ventriculoperitoneal shunting may be needed in patients with raised intracranial tension to alleviate the symptoms. Pharmacological management with the cysticidal drugs albendazole and praziquantel is indicated as these drugs help by reducing the parasite burden.  These drugs hasten the death of the cysts that may occur even in the absence of such treatment. Our patient responded well with prednisolone followed by albendazole therapy, and her MRI brain screening showed regression of the lesions. A case of human cysticercosis with such extensive dissemination and with subcutaneous swelling as the only presenting symptom is indeed very unusual.
| Acknowledgement|| |
We are grateful to the Director, School of Tropical Medicine, Kolkata, West Bengal, India for allowing us to work in this institution. We are also grateful to Professor D. K. Bera, Department of Helminthology, School of Tropical Medicine, Kolkata, West Bengal, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Baily GG. Cysticercosis. In: Cook GC, Zumla A, editor. Manson's Tropical Disease. London: Saunders; 2003. p. 1584-95.
Kumar A, Bhagwani DK, Sharma RK, Kavita, Sharma S, Datar S, et al
. Disseminated cysticercosis. Indian Pediatr 1996;33:337-9.
Bhalla A, Sood A, Sachdev A, Varma V. Disseminated cysticercosis: A case report and review of the literature. J Med Case Rep 2008;2:137.
Dixon HB, Lipscomb FM. Cysticercosis: An analysis and follow-up of 450 cases. Spec Rep Ser Med Res Counc (G B) 1961;299:1-58.
Cheung YY, Steinbaum S, Yuh WT, Chiu L. MR findings in extracranial cysticercosis. J Comput Assist Tomogr 1987;11:179-81.
Del Brutto OH, Rajshekhar V, White AC Jr, Tsang VC, Nash TE, Takayanagui OM, et al
. Proposed diagnostic criteria for neurocysticercosis. Neurology 2001;57:177-83.
Sotelo J, Escobedo F, Rodriguez-Carbajal J, Torres B, Rubio-Donnadieu F. Therapy of parenchymal brain cysticercosis with praziquantel. N Engl J Med 1984;310:1001-7.
Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]