Abstract
Disseminated cysticercosis is defined by the presence of multiple vesicular cystic lesions in the brain with cysts demonstrable in at least two other body parts. The exact course of disseminated cysticercosis is not known and the individual cysts either become inflamed or calcify. A patient’s quality of life is often poor and disseminated cysticercosis treatment is far from satisfactory. Anecdotal reports have suggested dual antiparasitic therapy to be beneficial for treating diffuse parenchymal neurocysticerci and might be worth trying in patients with massively infiltrating disseminated cysticercosis with concomitant corticosteroids.
Keywords
Disseminated cysticercosis (DCC) is defined by the presence of multiple vesicular cystic lesions in the brain with cysts demonstrable in at least two other body parts. 1 The exact course of DCC is not known and the individual cysts either become inflamed or calcify. 2 A patient's quality of life is often poor and DCC treatment is far from satisfactory. Anecdotal reports have suggested dual antiparasitic therapy to be beneficial for treating diffuse parenchymal neurocysticerci 3 and this might be worth trying in patients with massively infiltrating DCC with concomitant corticosteroids. 4
We report two patients (a 32-year old lady and a 42-year old man) who presented with drug refractory epilepsy owing to diffuse parenchymal neurocysticercosis and, on detailed evaluation, were found to have DCC. The first patient had nearly all her limb muscles lined with cysticerci simulating a “zebra appearance” on whole body MRI (Figure 1) and the second patient had concomitant parotid, thyroid and lung involvement, despite which he was asymptomatic (Figure 2). Both patients refused treatment upon being explained the possible risks of treatment and lack of clear evidence of their benefits.
Disseminated cysticercosis: MRI brain (a–d) shows diffuse neurocysticercosis (variable stages) in brain parenchyma with involvement of left temporalis muscle (arrow in b), few lesions shows peripheral enhancement (arrow in d). MRI coronal STIR whole body shows disseminated cysticercosis in bilateral upper, lower limb muscles and abdominal muscles.
Disseminated cysticercosis- MRI brain (a–e) shows diffuse neurocysticercosis in bilateral cerebral hemisphere with involvement of left temporalis muscle (arrow in a and b) and right parotid gland (arrow in e). NCCT image of thorax (f–h) shows diffuse cysticercosis in upper girdle muscles, left thyroid lobe, bilateral lower lobe of lung (arrow in g and h).
A randomized controlled trial is needed to assess the safety and efficacy of dual antiparasitic therapy in single and/or repeated courses. Also, should whole body MRI be sought for in patients with diffuse parenchymal neurocysticercosis to rule out other organ system involvement?
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
