Case report of an epidural cervical Onchocerca lupi infection in a 13-year-old boy.
A 13-year-old boy presented with fever and neck pain and stiffness, which was initially misdiagnosed as culture-negative meningitis. Magnetic resonance images of the brain and cervical spine demonstrated what appeared to be an intradural extramedullary mass at the C1-3 level, resulting in moderate cord compression, and a Chiari Type I malformation. The patient underwent a suboccipital craniectomy and a C1-3 laminectomy with intradural exploration for excisional biopsy and resection. The lesion containing the parasite was extradural, extending laterally through the C2-3 foramina. Inflammatory tissue secondary to Onchocerca lupi infection was identified, and treatment with steroids and doxycycline was initiated. At the 6-month follow-up, the patient remained asymptomatic, with MR images demonstrating a significant reduction in lesional size. However, 10 weeks postoperatively, the infection recurred, necessitating a second operation. The patient was treated with an additional course of doxycycline and is currently maintained on ivermectin therapy. This is the second reported case of cervical O. lupi infection in a human. In the authors' experience, oral doxycycline alone was insufficient in controlling the disease, and the addition of ivermectin therapy was necessary.
Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center;
Tsinsue
T
Chen
Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center;
Karam
K
Moon
Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital;
Daphne E
DE
deMello
The University of Arizona, College of Medicine-Phoenix; and.|Division of Neurosurgery, Maricopa Medical Center, Phoenix, Arizona.
Iman
I
Feiz-Erfan
Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center;
Nicholas
N
Theodore
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix Children's Hospital;
Ratan D
RD
Bhardwaj
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000209:etiology / Q000628:therapy*; D002574:Cervical Vertebrae / Q000601:surgery*; D003399:Craniotomy; D004318:Doxycycline / Q000627:therapeutic use; D005369:Filaricides / Q000627:therapeutic use; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D009855:Onchocerciasis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013117:Spinal Cord Compression / Q000209:etiology / Q000628:therapy*
D005369:Filaricides; D007559:Ivermectin; D004318:Doxycycline
Onchocerca lupi; cervical infection; parasite; spinal infection; spine