Neurocysticercosis in a 23-year-old Chinese man.
METHODS
Male, 23 FINAL DIAGNOSIS: Neurocysticerosis Symptoms: Diplopia • fever • headache • insomnia • neck stiffness • vomiting


METHODS
Albendazole Clinical Procedure: - Specialty: Neurology.


OBJECTIVE
Challenging differential diagnosis.


BACKGROUND
Neurocysticercosis is a brain infection caused by the larval stage of the tapeworm Taenia (T.) solium. It is the most important parasitic disease of the human central nervous system and represents the most common cause of acquired epilepsy in developing countries.


METHODS
Here, we report the case of a 23-year-old Chinese man who presented to the emergency department with a 7-day history of helmet headache radiating to the nuchal region and associated with vomiting, confusion, and fever. Cerebrospinal fluid (CSF) was clear, with increased pressure, lymphocytic pleocytosis, decreased glucose, and increased protein levels. Bacterial antigen detection test on CSF was negative, as were CSF bacterial and fungal cultures. Despite broad-spectrum antibiotic and antiviral therapy, the patient still complained of insomnia, diplopia, headache, neck stiffness, and pain in the sacral region. A second LP was performed and CSF had the same characteristics as the first LP. A brain and spinal cord MRI revealed widespread arachnoiditis and small septated cysts with CSF-like signal in the cisterna magna, within the fourth ventricle, and at the level of L3-L4. Cysticercus-specific immunoglobin G antibodies were detected by ELISA in the CSF. The patient received albendazole (15 mg/kg/day) and dexamethasone (5 mg/day) for 4 weeks, with progressive resolution of neurological symptoms.


CONCLUSIONS
This case shows that, even if rare, neurocysticercosis may be responsible for meningeal symptoms and should be included in the differential diagnosis, especially in patients from endemic countries.
Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
Rosa Fontana Del
RF
Vecchio
Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
Marilia Rita
MR
Pinzone
Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
Giuseppe
G
Nunnari
Division of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy.
Bruno
B
Cacopardo
Meningitis; Neurocysticercosis – diagnosis; Neurocysticercosis – physiopathology; Taenia solium