Disseminated Cysticercosis

A 23-year-old woman presented with a 1-month history of headache, vomiting, recurrent episodes of syncope, weight gain, and leg pain. A physical examination revealed several subcutaneous nodules on the patient's face and trunk. Exophthalmos, fundal hemorrhage, neck rigidity, and a hypertrophic appearance of the thigh and calf muscles were also noted. Magnetic resonance imaging (MRI) of the head revealed diffuse hyperintense septated cystic lesions in the parenchymal, intraventricular, and retroocular regions (Panel A). These lesions had a “cyst with dot sign” appearance, or eccentric scolex, which is characteristic of neurocysticercosis. Coronal MRI of the thighs also revealed numerous hyperintense lesions (Panel B). Antibodies to cysticerci were detected in the serum and cerebrospinal fluid by means of an enzyme-linked immunosorbent assay. An oval translucent cyst was resected from the gastrocnemius muscle, and histopathological examination of the cyst (Panel C) confirmed the diagnosis of cysticercosis. Cysticercosis is caused by the larvae of the parasite Taenia solium and can be acquired by consuming foods contaminated with feces that contain taenia eggs shed from a human carrier of the tapeworm. This patient was treated with mannitol and glucocorticoids to decrease edema and inflammation. Praziquantel and albendazole were used to treat the parasitic infection. Repeat imaging showed improvement, and the patient was asymptomatic 2 months after treatment.

一名23岁女性患者因头痛、呕吐、复发性晕厥、体重增加及下肢疼痛一个月就诊。体格检查发现患者面部及躯干有数个皮下结节。此外，还发现患者突眼，眼底出血，颈部强直，大腿及小腿肌肉肥厚。头部MRI显示脑室旁、脑室内及眼后区弥漫性高密度分隔的囊性病变（图A）。这些病变呈囊点征（或偏心头节），是神经系统囊虫病的特征性表现。大腿的冠状位MRI显示无数的高密度病变（图B）。通过酶联免疫吸附在血清及脑脊液中检测到猪囊虫抗体。从腓肠肌切除一个卵圆形半透明囊性病变，组织病理学检查（图C）确诊为囊虫病。囊虫病是猪囊虫的幼虫引起的疾病，猪绦虫携带者的粪便中含有绦虫卵，如果食用了被上述粪便污染的食物则可以致病。本例患者接受甘露醇和糖皮质激素治疗以减轻水肿和炎症。吡喹酮和阿苯达唑用于治疗寄生虫感染。复查影像学显示病情改善，患者接受治疗2个月后症状消失。