Shah Dhruv A, Ghodke Ashok M, Surme Shahish S, Agrawal Laksh A, Velankar Ameya H
Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India.
J Orthop Case Rep. 2024 Feb;14(2):140-144. doi: 10.13107/jocr.2024.v14.i02.4248.
Cysticercosis leads to a cyst formation known to occur due to the Taenia solium parasite. Patients normally present with seeding and formation of the cysts in the central nervous system (CNS) as neurocysticercosis (NCC). Intramuscular cysts are rare presentations and are mostly incidental findings in NCC patients. We present a rare case of a rapidly progressing isolated cysticercosis of the flexor digitorum profundus (FDP) muscle leading to a pseudotumor and presenting with pseudo-Volkmanns contracture and a positive Volkmanns sign.
A 26-year-old right-hand dominant vegetarian female presented with a 3-month-old progressive swelling on her right forearm with no antecedent trauma history. A positive Volkmann's sign was present. Radiographs were normal, and ultrasonography showed a cysticercus cyst in the FDP muscle belly with a multiseptated abscess around the tendons of the middle, ring, and little fingers at the musculotendinous junction. Bones and nerves were spared. After ruling out CNS involvement and providing oral antiparasitic cover, she underwent a successful surgical exploration with cyst excision, debridement, and freeing of the involved tendons. Immediately post-operatively, she was able to completely extend the three involved fingers without flexion at the wrist joint (resolving Volkmann's sign). She reported significant improvements in the functions of daily life. She was protected with a splint for 2 weeks. There was no recurrence, and the swelling subsided. Histo-pathology reports depicted cysts with visible scolices.
It is important to consider the possibility of 'Myoparasitism' in atraumatic cases showing contractures. Clinching the right diagnosis is essential and best done with a multidisciplinary approach with ultrasonography, magnetic resonance imaging, electromyography, and nerve conduction velocity studies. It is essential to rule out life-threatening NCC beforehand and offer prophylaxis. Surgical exploration is generally indicated to regain normal function and free the involved structures.
囊尾蚴病会导致因猪带绦虫寄生虫而出现囊肿形成。患者通常会以神经囊尾蚴病（NCC）的形式出现囊肿在中枢神经系统（CNS）的播散和形成。肌肉内囊肿是罕见的表现，大多是NCC患者的偶然发现。我们报告一例罕见病例，即指深屈肌（FDP）肌肉迅速进展的孤立性囊尾蚴病，导致假性肿瘤，并表现为假性Volkmanns挛缩和阳性Volkmanns征。
一名26岁右利手素食女性，右前臂出现进行性肿胀3个月，无前驱创伤史。存在阳性Volkmann征。X线片正常，超声检查显示FDP肌腹有一个囊尾蚴囊肿，在中、环指和小指肌腱在肌肉肌腱交界处周围有一个多房性脓肿。骨骼和神经未受累。在排除中枢神经系统受累并给予口服抗寄生虫治疗后，她成功接受了手术探查，切除囊肿、清创并松解受累肌腱。术后即刻，她能够完全伸直三个受累手指，而腕关节无屈曲（Volkmann征消失）。她报告日常生活功能有显著改善。她用夹板固定了2周。无复发，肿胀消退。组织病理学报告显示囊肿内可见头节。
在出现挛缩的非创伤性病例中，考虑“肌内寄生虫病”的可能性很重要。做出正确诊断至关重要，最好采用超声、磁共振成像、肌电图和神经传导速度研究等多学科方法。必须事先排除危及生命的NCC并提供预防措施。一般需要进行手术探查以恢复正常功能并松解受累结构。
