Neurocysticercosis with initial clinical presentation of acute cysticercal meningitis coexisting with anterior chamber intraocular cysticercosis: a case report from a rural institute in India
Keywords:
Neurocysticercosis, Intraocular cysticercosis, Acute cysticercal meningitis, Cerebrospinal fluid eosinophiliaAbstract
Acute cysticercal meningitis coexisting with intraocular cysticercosis is an extremely infrequent clinical presentation of neurocysticercosis. We report a 26 year old male, who presented with signs and symptoms of acute eosinophilic cysticercal meningitis with intraocular cysticercosis in the anterior chamber of left eye. Diagnosis was confirmed with demonstration of cerebrospinal fluid (CSF) eosinophilia, cysticercus specific IgG antibodies by CSF ELISA, sterile bacterial, mycobacterial and fungal CSF cultures, cystic lesions containing characteristic scolices consistent with neurocysticercosis on neuroimaging and histopathological demonstration of cysticercus cellulosae larva viscoexpressed from the eye. The importance of having high index of clinical suspicion highlighted along with need of examining cerebrospinal fluid with Wright-Giemsa stain so as not to miss cerebrospinal fluid eosinophilia and diagnosis of this extremely under-reported clinical entity, when there is concurrent presence of brain and other extracerebral lesions consistent with cysticercosis.
References
Garcia HH, Del Brutto OH. Taenia solium cysticercosis. Infect Dis Clin North Am. 2000;14(1):97-119.
Joubert J. Cysticercal meningitis: a pernicious form of neurocysticercosis which responds poorly to prazequantel. S Afr Med J. 1990;77(10):528-30.
Kai S, Vanathi M, Vengayil S, Panda A. Viscoexpression of large free floating cysticercus cyst from the anterior chamber of the eye by double incision technique. Indian J Med Microbiol. 2008;26(3):277-9.
Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proano JV, et al. Treatment of neurocysticercosis: current status and future research needs. Neurol. 2006;67(7):1120-7.
Del Brutto OH, Rajshekhar V, White AC Jr, Tsang VC, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurol. 2001;57(2):177-83.
Sardana V, Sharma D, Agarwal S, Sardana A, Khandelwal G, Aseri RK. Solitary cysticercal granuloma coexisting with cysticercal meningitis. Int J Basic Applied Med Sci.. 2013;3(2):218-2.
Mishra D, Sharma S, Gupta S, Das M, Chauhan D. Acute cysticercal meningitis: missed diagnosis. Indian J Pediatr. 2006;73 (9):835-7.
Cardenas G, Jung H, Rios C, Fleury A, Soto-Hernandez JL. Severe cysticercal meningitis: clinical and imaging characteristics. Am J Trop Med Hyg. 2010;82(1):121-5.
Coker-Vann MR, Subianto DB, Brown P, Diwan AR, Desowitz R, Garruto RM, et al. ELISA antibodies to cysticerci of taenia solium in human population in New Guinea, Oceania and Southeast Asia. Southeast Asian J Trop Med Pub Health. 1981;12(4):499-505.
Wang CH, Gao SF, Guo YP. Diagnostic significance of eosinophilia of the cerebrospinal fluid in cerebral cysticercosis. Chin Med J (Engl). 1993;106(4):282-4.