A case report on Cysticercosis

Dr. S. S. Ahmed, Dr. Shuvamay Chowdhury
 
A boy of 12 years hailing from Bogra, Bangladesh was admitted in united hospital with altered level of consciousness for last two months. Initially the boy developed complaints of headache, fever, chest pain and cough three months back for which he was treated locally as a case of right sided parapneumonic effusion with multiple courses of different antibiotics.

Later he was shifted   to a hospital at Dhaka for further evaluation. During this period he developed abnormal aggressive behavior with irrelevant talking and two episodes of convulsion for which he was evaluated with MRI brain at that hospital which showed small ring enhancing lesions.

Within two weeks he neurologically deteriorated more and transferred to PICU there. Repeat brain scan showed dramatic increase of size of the lesions with extensive perilesional oedema. Seeing that he was started on anti-TB and Anti-fungal drug at that hospital. Later biopsy was done there which was inconclusive. As he remained static, he was shifted to our hospital. We performed biopsy from the largest lesion with decompression of the cystic space. Considering the imaging  and intra-operative finding, we strongly suspect the case as a Neuro Cysticercosis.(caused by T solium, the pork tapeworm).

Opinion from medical colleagues was also the same. So after decompression we started on Albendazole, omitting anti-TB and anti-fungal drugs. We plan to continue Albendazole for one month and he was discharged with advice to follow up after one month. After one month when he came, we did a contrast CT scan which showed dramatic decreases in the number of the lesions. Now, he can talk relevantly and he has no new complains. His parents are planning to send him school from next year.