Singh Barundeep, Kaur Chrisinder, Ananthakrishnan R, Sambyal Bharat S, Chauhan Prabhat
Department of General Medicine, INHS Asvini, Mumbai, India.
Department of Dermatology, INHS Asvini, Mumbai, India.
J Med Case Rep. 2024 Dec 24;18(1):621. doi: 10.1186/s13256-024-04992-4.
Cysticercosis, a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium, predominantly affects cerebral and ocular tissues. The subcutaneous manifestation of this disease is a relatively uncommon clinical occurrence. Previously very few or no cases of cysticercosis presenting as subcutaneous solitary painful swelling have been reported in the literature. In previous reports, the swelling was described as painless and not solitary.
We present a rare case of subcutaneous cysticercosis in an Indian female in her forties, localized over the left scapular region, exhibiting gradual enlargement over 4 weeks. The patient experienced pain and intense itching without neurological or ocular involvement. Physical examination revealed a well-defined nodular swelling measuring approximately 3.5 cm × 3 cm, painful, nonfluctuating, nonreducible, soft to firm consistency, with no attachment to the underlying muscle, observed at the inferior angle of the left scapula. The overlying skin was tense, glossy, erythematous, and indurated, with mild superficial scaling at a few places and excoriation marks around the swelling. No similar swelling was found elsewhere on the body. The rest of the systemic and physical examination was unremarkable. The clinical diagnosis included an abscess, infected sebaceous cyst, lipoma with inflamed overlying skin, and a remote possibility of subcutaneous cysticercosis. Stool examination for ova, cysts, and parasites was unremarkable. Cysticercus IgG antibody by enzyme-linked immunosorbent assay was negative. A chest X-ray and radiograph of the left scapular region were normal. Fine needle aspiration biopsy of the lesion was planned but could not be completed as the patient did not consent. Local part ultrasonography revealed a well-defined cystic area of 1.9 × 1.1 × 1.6 cm (anteroposterior × transverse × craniocaudal) with peripheral calcified streaks (scolex) and surrounding edema suggestive of subcutaneous cysticercosis. The diagnosis was established by the ultrasonography of the lesion suggesting features consistent with cysticercus, and later established by complete resolution after a course of albendazole. Management involved a 3-week course of albendazole and 5 days of paracetamol for pain, leading to the full resolution of swelling and symptoms. On follow-up at 1 month, the swelling had disappeared with no new swelling or symptoms.
Subcutaneous cysticercosis is an unusual presentation of Taenia solium infestation that requires a high index of suspicion for accurate diagnosis. This case report emphasizes the importance of considering parasitic infections in the differential diagnosis of subcutaneous nodules. Early diagnosis and appropriate management are crucial for preventing complications and improving patient outcomes.
囊尾蚴病是由猪肉绦虫（猪带绦虫）的幼虫阶段引起的寄生虫感染，主要影响脑和眼组织。这种疾病的皮下表现是一种相对不常见的临床情况。以前，文献中很少或没有报道过以皮下孤立性疼痛性肿胀为表现的囊尾蚴病病例。在以前的报道中，肿胀被描述为无痛且非孤立性的。
我们报告一例罕见的皮下囊尾蚴病病例，患者为一名40多岁的印度女性，病变位于左肩胛区，在4周内逐渐增大。患者经历疼痛和剧烈瘙痒，无神经或眼部受累。体格检查发现左肩胛下角有一个边界清晰的结节性肿胀，大小约为3.5厘米×3厘米，有疼痛，无波动感，不可还纳，质地由软至硬，与下方肌肉无粘连。覆盖的皮肤紧张、光滑、红斑样且硬结，在一些部位有轻度浅表鳞屑，肿胀周围有抓痕。身体其他部位未发现类似肿胀。全身及体格检查的其余部分无异常。临床诊断包括脓肿、感染性皮脂腺囊肿、伴有皮肤炎症的脂肪瘤以及皮下囊尾蚴病的极小可能性。粪便虫卵、囊肿和寄生虫检查无异常。酶联免疫吸附测定法检测囊尾蚴IgG抗体为阴性。胸部X线和左肩胛区X线片正常。计划对病变进行细针穿刺活检，但由于患者不同意而未完成。局部超声检查显示一个边界清晰的囊性区域，大小为1.9×1.1×1.6厘米（前后径×横径×头尾径），周边有钙化条纹（头节）和周围水肿，提示皮下囊尾蚴病。病变的超声检查提示符合囊尾蚴的特征，从而确立诊断，随后在服用阿苯达唑一个疗程后完全消退进一步证实了诊断。治疗包括服用3周的阿苯达唑和5天的对乙酰氨基酚以止痛，肿胀和症状完全消退。在1个月的随访中，肿胀消失，无新的肿胀或症状。
皮下囊尾蚴病是猪带绦虫感染的一种不寻常表现，需要高度怀疑才能准确诊断。本病例报告强调了在皮下结节的鉴别诊断中考虑寄生虫感染的重要性。早期诊断和适当治疗对于预防并发症和改善患者预后至关重要。
