Abraham Ananth P, Bindra Mandeep Singh, Chacko Ari George
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.
Neurol India. 2020 May-Jun;68(3):684-687. doi: 10.4103/0028-3886.288991.
The most common presenting form of neurocysticercosis in the Indian subcontinent is a solitary cysticercus granuloma (SCG). Patients with typical SCGs almost never require any form of surgical intervention. Herein, we report an extremely rare case of bacterial superinfection of a left frontal SCG in a 23-year-old female, resulting in severe perilesional edema and mass effect. The patient had to undergo an emergency left decompressive hemicraniectomy and excision of the infected granuloma. Serum enzyme-linked immunoelectrotransfer blot (EITB) for cysticercal antibodies was positive and histopathological examination of the lesion revealed a cysticercus. The culture of the pus from within the lesion grew vancomycin-resistant Enterococcus spp. for which she was treated with linezolid for 6 weeks. At 6 months follow-up, she had residual motor dysphasia, right homonymous hemianopia, and right hemiparesis but was steadily improving. Secondary bacterial infection of an SCG is very uncommon and can be devastating. A high index of suspicion is therefore required when there is disproportionate perilesional edema and mass effect.
在印度次大陆，神经囊尾蚴病最常见的表现形式是单个囊尾蚴肉芽肿（SCG）。典型SCG患者几乎从不需任何形式的手术干预。在此，我们报告一例极其罕见的病例，一名23岁女性的左侧额叶SCG发生细菌二重感染，导致严重的病灶周围水肿和占位效应。患者不得不接受急诊左侧减压性颅骨切除术并切除受感染的肉芽肿。囊尾蚴抗体的血清酶联免疫电转移印迹法（EITB）呈阳性，病变的组织病理学检查显示有囊尾蚴。病灶内脓液培养出耐万古霉素肠球菌属，为此她接受了6周的利奈唑胺治疗。在6个月的随访中，她有残留运动性言语障碍、右侧同向性偏盲和右侧偏瘫，但病情在稳步改善。SCG的继发性细菌感染非常罕见，且可能具有破坏性。因此，当出现不成比例的病灶周围水肿和占位效应时，需要高度怀疑。
