Simultaneous Brain and Ocular Cysticercosis in a Five-Year-Old Boy

Abstract

To the Editors: ysticercosis caused by the parasitic tapeworm Taenia solium is a major public health problem in developing countries and also in developed countries as a result of increasing migration.1,2 The disease occurs when humans become the intermediate host in the life cycle of T. solium by ingesting its eggs from contaminated food.1,2 Neurocysticercosis is the commonest helminthic disease of the human nervous system.1,2 We present a 5-year-old boy who had simultaneous brain and ocular cysticercosis. In September 2005 this child was admitted because of multiple generalized seizures to another hospital near Mumbai. A computed tomography scan of the brain revealed multiple ring-enhancing cystic lesions with perilesional edema. A few cysts had an enhancing nodule suggestive of a scolex. Normal physical and neurologic examination findings, negative Mantoux test, normal chest radiograph, and absence of chronic fever or anorexia excluded central nervous system tuberculosis. Direct ophthalmoscope findings were normal. With a diagnosis of multiple brain cysticercii the child was treated with oral prednisone (2 mg/kg/d) for 3 days, followed by oral albendazole (15 mg/kg/d for 4 weeks) and discharged after a 7-day stay.3 Oral valproic acid was given to prevent recurrent seizures.3 In January 2006, the parents brought the child to our outpatient department for complaints of repetitive closure of the left eye lid and watering from left eye. On enquiry it was found that these symptoms had begun in October 2006, while the child was receiving albendazole therapy. As the child did not complain of pain, the parents completed the albendazole course. On examination it was found that the child had almost no perception of light in his left eye. The remainder of the physical examination was normal. The child was hospitalized. Indirect ophthalmoscopic examination revealed retinal detachment in the left eye. Computed tomography scan of the brain with orbital cuts showed multiple ring-enhancing cystic lesions, some with perilesional edema, and a cystic lesion along the posterior retina in the left eye (Fig. 1). Ultrasonographic examination of the left eye showed a subretinal cyst (9 × 9 mm) with 2 calcified specks with surrounding retinal detachment. The child was treated with oral prednisone (2 mg/kg/d for 3 weeks and then tapered and continued on 1 mg/kg/d). During the next 4 months the child developed inflammatory phthisis and lost all vision in his left eye.FIGURE 1.: Contrast-enhanced CT scan orbit showing cystic lesion along posterior retina in left eye (subretinal cysticercosis).The recommended treatment of intraocular cysticercosis is surgical removal of the intact cyst.4 Larvicidal drugs, such as albendazole, are contraindicated in ocular cysticercosis because the degeneration of the cyst can cause severe inflammation and visual loss.4 Simultaneous occurrence of brain and subretinal cysticercosis is extremely rare.5 We are not aware of any other reports of iatrogenic blindness developing in a child with this clinical condition. This case has important diagnostic and therapeutic implications. Indirect ophthalmologic examination or ultrasonographic examination of the eyes of children with neurocysticercosis should be considered before treatment of neurocysticercosis. Sunil Karande, MD Nilesh Kumbhare, DCH Department of Pediatrics Lokmanya Tilak Municipal Medical College and General Hospital Sion, Mumbai India [email protected]