Dual Cestode Infection in a Thai Patient (Spinal Sparganosis and Racemose Neurocysticercosis): A Case Report
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Unexpected drug reaction , Rare disease, Clinical situation which can not be reproduced for ethical reasons
Verajit Chotmongkol, Pewpan M. Intapan, Kritsakorn Jingjit
(Department of Medicine, Khon Kaen University, Khon Kaen, Thailand)
Am J Case Rep 2018; 19:1090-1095
Spinal sparganosis and racemose (grape-like) neurocysticercosis are rare diseases. Co-infection with spinal sparganosis and racemose neurocysticercosis has never been reported in the English-language literature.
CASE REPORT: A 41-year-old male presented after having experienced left hip pain with radiation to the leg, progressive weakness and numbness of the left leg, and difficulty urinating for 4 years, all of which was caused by spinal sparganosis. He had also experienced progressive vision and hearing loss on the right side for 3 years, which were caused by racemose neurocysticercosis. Magnetic resonance imaging (MRI) of the lumbosacral spine and the brain revealed intrinsic spinal cord lesion and racemose neurocysticercosis, respectively. Spinal sparganosis was diagnosed by histological examination and an immunochromatographic test. It was treated with a high-dose of praziquantel (75 mg/kg/day) combined with cimetidine; without clinical improvement. Treatment consisted of racemose neurocysticercosis with albendazole for 2 months. A follow-up MRI of the brain revealed a minimal reduction in the amount of racemose neurocysticercosis. Repeat treatment with albendazole was administered. However, further MRI examination of the brain revealed the condition to be unchanged. Vision and hearing loss had also not improved.
CONCLUSIONS: In this case report, we describe a middle-aged man who presented with spinal cord symptoms (hip pain, progressive weakness and numbness of the leg, and difficulty urinating) and cranial nerve palsies (vision and hearing loss) caused by spinal sparganosis and racemose neurocysticercosis, respectively. Neurological symptoms did not improve with anthelmintic drugs.
Keywords: albendazole, Central Nervous System Parasitic Infections, Neurocysticercosis