Pathology Outlines
Subcutaneous cysticercosis with neurocysticercosis (20x)
Case History:
A 21 year old woman presented with a 3 x 2 cm swelling in the right forearm for one year.
The swelling was painful for two weeks. She gave a history of one episode of generalized tonic clonic seizure, six months ago with loss of consciousness in the post-ictal period.
Physical findings and complete hemogram were unremarkable. Biochemical parameters including blood sugar, serum urea and creatinine were normal. ESR was mildly elevated and was 32 mm/hour.
Excision of the forearm swelling was performed.
Discussion:
Histopathology revealed a parasite with irregularly-shaped membranous foldings and scolices representing Cysticercus larva in subcutaneous tissue.
Subsequently, Computerized Tomography (C.T.) imaging revealed a small hyperdense lesion in the right frontal lobe surrounded by perilesional edema. Post contrast image revealed irregular enhancement. C.T. features were suggestive of neurocysticercosis.
Cysticercosis (tapeworm infection) is the most common parasitic disease worldwide with an estimated prevalence of 50 million affected people (Surg Neurol 2005;63:123). It is endemic in Mexico, Asia, Latin America, Sub-Saharan Africa and India (Infect Dis Clin North Am 2000;14:97).
The larval stage of Taenia solium (pig tapeworm) is Cysticercus cellulosae. It enters the human body by ingestion of food or water contaminated with eggs of Taenia solium, through endogenous autoinfection and also by reverse peristalsis. Del Brutto has proposed a diagnostic criteria for neurocysticercosis of which our case has one absolute criterion and one major criterion (J Neurol Sci 1996;142:1).
Cysticercosis affects subcutaneous tissue, muscles, eyes and the brain. Subcutaneous tissue and muscular involvement usually comes to focus when pain develops in the affected area. Cigar shaped calcification in soft tissue is seen in radiological studies. Ocular cysticercosis occurs in the conjunctiva, vitreous and in the subretinal space, the latter leading to retinal detachment. Fundoscopic examination may show freely floating cysticerci in the vitreous and anterior chamber. Ophthalmic examination in our patient was normal.
Neurocysticercosis is considered as one of the leading causes of adult onset seizures worldwide. Parenchymal neurocysticercosis affects the brain parenchyma while extraparenchymal neurocysticercosis has parasites in the ventricles, cisterns, subarachnoid space or in the spinal cord. Convulsions, meningitis and intracranial hypertension occur due to neurocysticercosis. Intracranial herniations, stroke and status epilepticus are complications due to neurocysticercosis.
Approximately half of the patients with cysticercosis present with subcutaneous nodules (Fitzpatrick's Dermatology in General Medicine (2012), 8th ed). However, the
association of neural and subcutaneous cysticercosis is rare (Indian J Dermatol Venereol Leprol 2008;74:385).
The case is discussed to emphasize the importance of neurologic and ophthalmic examination in patients with subcutaneous cysticercosis. The patient recovered by treatment with Praziquantel and steroids in tapering doses.
Contributed by: Dr. Thiriveni Balajji and Dr. M. Kavitha, Coimbatore Medical College (India)
See topic here.
Subcutaneous cysticercosis with neurocysticercosis (20x)
Case History:
A 21 year old woman presented with a 3 x 2 cm swelling in the right forearm for one year.
The swelling was painful for two weeks. She gave a history of one episode of generalized tonic clonic seizure, six months ago with loss of consciousness in the post-ictal period.
Physical findings and complete hemogram were unremarkable. Biochemical parameters including blood sugar, serum urea and creatinine were normal. ESR was mildly elevated and was 32 mm/hour.
Excision of the forearm swelling was performed.
Discussion:
Histopathology revealed a parasite with irregularly-shaped membranous foldings and scolices representing Cysticercus larva in subcutaneous tissue.
Subsequently, Computerized Tomography (C.T.) imaging revealed a small hyperdense lesion in the right frontal lobe surrounded by perilesional edema. Post contrast image revealed irregular enhancement. C.T. features were suggestive of neurocysticercosis.
Cysticercosis (tapeworm infection) is the most common parasitic disease worldwide with an estimated prevalence of 50 million affected people (Surg Neurol 2005;63:123). It is endemic in Mexico, Asia, Latin America, Sub-Saharan Africa and India (Infect Dis Clin North Am 2000;14:97).
The larval stage of Taenia solium (pig tapeworm) is Cysticercus cellulosae. It enters the human body by ingestion of food or water contaminated with eggs of Taenia solium, through endogenous autoinfection and also by reverse peristalsis. Del Brutto has proposed a diagnostic criteria for neurocysticercosis of which our case has one absolute criterion and one major criterion (J Neurol Sci 1996;142:1).
Cysticercosis affects subcutaneous tissue, muscles, eyes and the brain. Subcutaneous tissue and muscular involvement usually comes to focus when pain develops in the affected area. Cigar shaped calcification in soft tissue is seen in radiological studies. Ocular cysticercosis occurs in the conjunctiva, vitreous and in the subretinal space, the latter leading to retinal detachment. Fundoscopic examination may show freely floating cysticerci in the vitreous and anterior chamber. Ophthalmic examination in our patient was normal.
Neurocysticercosis is considered as one of the leading causes of adult onset seizures worldwide. Parenchymal neurocysticercosis affects the brain parenchyma while extraparenchymal neurocysticercosis has parasites in the ventricles, cisterns, subarachnoid space or in the spinal cord. Convulsions, meningitis and intracranial hypertension occur due to neurocysticercosis. Intracranial herniations, stroke and status epilepticus are complications due to neurocysticercosis.
Approximately half of the patients with cysticercosis present with subcutaneous nodules (Fitzpatrick's Dermatology in General Medicine (2012), 8th ed). However, the
association of neural and subcutaneous cysticercosis is rare (Indian J Dermatol Venereol Leprol 2008;74:385).
The case is discussed to emphasize the importance of neurologic and ophthalmic examination in patients with subcutaneous cysticercosis. The patient recovered by treatment with Praziquantel and steroids in tapering doses.
Contributed by: Dr. Thiriveni Balajji and Dr. M. Kavitha, Coimbatore Medical College (India)
See topic here.