Neurocysticercosis in a European Traveler Returning From India, Primarily Suspected as Neoplasia
2. Del Brutto OH, Nash TE, Garcia HH. Cysticerci-related single parenchymal brain enhancing lesions in non-endemic countries. J Neurol Sci 2012; 15:32–36. 3. Del Brutto OH. Neurocysticercosis. Continuum (Minneap Minn) 2012; 18:1392–1416.
To the Editor-in-Chief: The case reported by Salzer and colleagues1 shows a typical problem that is observed during the evaluation and management of patients with suspected neurocysticercosis in nonendemic areas. According to their description, a woman—with history of frequent travel to India—was evaluated because of a subcutaneous nodule that was conﬁrmed to be a Taenia solium cysticercus after biopsy and histopathological examination. Then, this neurological asymptomatic patient underwent computed tomography (CT) scan of the head, and the authors found multiple parenchymal brain calciﬁcations but no viable cysts (CT not shown). On this basis, they decided to start sequential therapy with two cysticidal drugs (praziquantel and albendazole), and as a result of this, the patient experienced two generalized seizures soon after those trials had been completed. Repeated CT revealed multiple cysticerci in the colloidal or granular stages surrounded by edema (CT not shown). Some logical questions arise. Why did the authors use cysticidal drugs if CT only showed parenchymal brain calciﬁcations? Why did they not request for magnetic resonance imaging (MRI) before therapy if they suspected that some viable cysts may be hiding because of poor resolution of CT? And, in the event that MRI was unavailable or contraindicated and the authors still had the suspicion that viable cysts could be in the brain, why did they not use antiepileptic drugs? Misinterpretation of the different patterns of disease expression of neurocysticercosis in terms of parasite location, viability of lesions, and severity of the infection may be responsible for a number of ‘‘adverse reactions’’ related to the use of cysticidal drugs or even to the practice of unnecessary surgical procedures.2 These complications are completely avoidable provided current guidelines for therapy are followed.3 Reports such as this may create confusion on the actual value and safety of cysticidal drugs among readers who are not familiar with the disease.