|Year : 2012 | Volume
| Issue : 4 | Page : 132-134
Ravala Siddeswari, Siddula Manohar, B Sudarsi
Upgraded Department of Medicine, Osmania General Hospital, Osmania Medical College, Afzalgung, Hyderabad, Andhra Pradesh, India
|Date of Web Publication||19-Sep-2014|
Dr. Ravala Siddeswari
Upgraded Department of Medicine, Osmania General Hospital, Afzalgunz, Hyderabad, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Cutaneous cysticercosis in human is an uncommon parasitic infection, mostly presents as asymptomatic subcutaneous nodules with prevalence of 12.9-38% in India. It may occur as an isolated feature or as part of the disseminated cysticercosis. Here with we report a 23 years female presenting with 6 months duration of seizures and subcutaneous nodules poorly responding to anti epileptics. Diagnosis of cutaneous cysticercosis was made by biopsy of subcutaneous nodules and patient responded to treatment.
Keywords: Cutaneous cysticercosis, neurocysticercosis, skin biopsy, subcutaneous nodules
|How to cite this article:|
Siddeswari R, Manohar S, Sudarsi B. Cutaneous cysticercosis. J Acad Med Sci 2012;2:132-4
| Introduction|| |
Cysticercosis is a tissue infection caused by larval stage of the cestodes, Taenia solium (human pork tapeworm). Infection is acquired by ingestion of eggs through contaminated food,water or by means of autoinoculation as shown in [Figure 1] and [Figure 2]. Incubation period is variable i.e., months to years. Cysticercusis a liquid filled vesicle with a three layered wall and scolex.In the majority of cases, brain, eyes or skeletal muscle are involved. Brain is the most common location accounting for 60-90% of all cases.
| Case Report|| |
A 23 year female presented with complaints of seizures (generalised tonic clonic) of 10 minutes duration and asscociated with postictal confusion.There was history of intermittent headache of moderate intensity for the past one month.She is married and had a history of abortion 2 years back. She was on Tegrital SR 200 mg BID for the past one month.Physical examination revealed two subcutaneous nodules over left elbow, lateral aspect of left thumb which measured 2cm × 1cm, 3cm × 2 cm respectively.These nodules were well defined, non tender, firm, mobile, with a smooth surface.Vital data was normal. She was drowsy but arousable on day 1 of admission which improved by day 2. There was no cranial nerve abnormalities or motor deficits or signs of meningitis.Other system examinations were unremarkable. Investigations revealed stool for ova cyst- negative, complete urine examination was normal, complete blood picture - haemoglobin- 11 g/dl, red blood cells - 4.5 million/cc, normocytic, normochromic white blood cells - 5500/cc, Neutrophils - 55%, Lymphocytes - 30%, Eosinophils - 1%, Monocytes - 2%, platelet count - 2 lakh/cc, erythrocyte sedimentation rate - 40 mm 1st h, 70mm 2ndhour, Blood urea - 26 mg%, Serum creatinine - 0.9 mg/dl serum Na-135 mEq/L, serum K-4.0 mEq/L. Ultrasonography Abdomen was normal. HIV was non-reactive. Chest X-ray was normal. Sputum for acid-fast bacilli was negative. Plain computed tomography brain revealed multiple hypo dense lesions in both cerebral hemispheres.With contrast enhancement, multiple small ring enhancing lesions in both cerebral hemispheres and cerebellum were revealed. Magnetic resonance imaging brain revealed multiple small altered signal intensity lesions which are hypo intense on T1 and hyperintense on T2 and suggested scolex noted in bilateral cerebral, bilateral cerebellar and brain stem regions and lesions at right temporal, right parietal and bilateral frontal and bilateral occipital areas showing minimal perilesional edema suggestive of neurocysticercosis as shown in [Figure 3]. Fundus examination was normal. Biopsy of skin nodule revealed cystic lesion with fibrocollagenous cell wall lined by flattened epithelium with undulations along with inflammatory cell collection, predominantly composed of eosinophils, lymphocytes and plasma cells suggestive of cysticercosis as shown in [Figure 4].
|Figure 3: Computed tomography contrast multiple small ring enhancing lesions in both cerebral hemispheres and cerebellum. Magnetic resonance imaging multiple small altered signal intensity lesions which are hypo intense on T1 and hyper intense on T2 and with suggested scolex are noted in bilateral cerebral, bilateral cerebellar and brain stem regions|
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|Figure 4: Biopsy; cystic lesion showed fibrocollagenous cell wall lined by flattened epithelium with undulations along with inflammatory cell collection, predominantly composed of eosinophils, lymphocytes and plasma cells S/O cysticercosis|
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| Discussion|| |
In India, the first case of cysticercosis involving the skin was recorded by Campbell and Thomson in 1912.  Earlier, in 1888, Armstrong  had published the first case of cerebral cysticercosis which was followed by the report of a case of mucous membrane involvement by cysticercus.  Cysticercosis is the most common parasitic disease of the central nervous system in the world, but cysticercosis cutis has been reported much less frequently.  The infection is common in India, Africa, Mexico and South America.  It may occur as a isolated feature or as part of disseminated systemic cysticercosis.  The syndrome of DCC, is characterized by pseudo muscular hypertrophy (100%), palpable subcutaneous nodules (87%), seizures (78%) and abnormal mentation (65%). Rare manifestations of CNS cysticercosis include optic nerve involvement,dorsal midbrain syndrome, isolated bilateral ptosis, papillitis, cerebral hemorrhage, painful cervical radiculopathy and paraplegia due to intra medullary cyst in the spinal cord. Our patient improved clinically with albendazole and steroids and antiepileptics. Prophylactic dose of albendazole was given to her family members.
| References|| |
|1.||Campbell TV, Thomson TT. A case of multiple cysticercuscellulosae. Indian Med Gaz 1912;47:145-6. |
|2.||Armstrong H. Proceedings of South Indian Branch of British Medical Association: Cysticercosis. Indian Med Gaz 1888;23:251-2. |
|3.||Elliot RH, Ingram AC. A case of sub conjunctival cysticercus cellulosae. Indian Med Gaz 1911;46:215-7. |
|4.||Banerjee D. Cysticercosis. J Indian Med Assoc 1958; 30:157-9. |
|5.||Valia RG, Valia AR. IADVL Textbook of Dermatology. 3 rd Ed., Mumbai, India: Bhalani Publishing House; 2010. p. 441-4. |
|6.||Wadia NH. Neurocysticercosis, Neurologic Practice: An Indian Perspective. 1 st ed., Ch. 10. Elsevier; 2005. p. 215-51. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]