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Case Reports
. 2013 Dec;51(6):739-42.
doi: 10.3347/kjp.2013.51.6.739. Epub 2013 Dec 31.

Sparganosis presenting as cauda equina syndrome with molecular identification of the parasite in tissue sections

Adhiratha Boonyasiri  1 , Pornsuk Cheunsuchon  2 , Prajak Srirabheebhat  3 , Hiroshi Yamasaki  4 , Wanchai Maleewong  5 , Pewpan M Intapan  5
Affiliations
Case Reports

Sparganosis presenting as cauda equina syndrome with molecular identification of the parasite in tissue sections

Adhiratha Boonyasiri et al. Korean J Parasitol. 2013 Dec.

Abstract

A 52-year-old woman presented with lower back pain, progressive symmetrical paraparesis with sensory impairment, and sphincter disturbance. Magnetic resonance imaging (MRI) of the whole spine revealed multiple intradural extramedullary serpiginous-mass lesions in the subarachnoid space continuously from the prepontine to the anterior part of the medulla oblongata levels, C7, T2-T8, and T12 vertebral levels distally until the end of the theca sac and filling-in the right S1 neural foramen. Sparganosis was diagnosed by demonstration of the sparganum in histopathological sections of surgically resected tissues and also by the presence of serum IgG antibodies by ELISA. DNA was extracted from unstained tissue sections, and a partial fragment of mitochondrial cytochrome c oxidase subunit 1 (cox1) gene was amplified using a primer set specific for Spirometra spp. cox1. After sequencing of the PCR-amplicon and alignment of the nucleotide sequence data, the causative agent was identified as the larva of Spirometra erinaceieuropaei.

Keywords: Spirometra erinaceieuropaei; cauda equina syndrome; molecular identification; sparganosis.

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Figures

Fig. 1
Fig. 1
Magnetic resonance of lumbosacral spine sagittal T2W image (A) and sagittal T2W with fat suppression image (B) shows abnormal lower lumbar spinal cord, conus medullaris, and cauda equina. Multiple heterogeneously serpigineous lesion filling within T12 to S1 of the thecal sac.
Fig. 2
Fig. 2
Histopathological findings of the resected lesion. (A) Section of a degenerating cestode larva (molecular confirmed as Spirometra erinaceieuropaei) with homogenously eosinophilic and irregularly ridged tegument. Calcareous bodies and inflammatory cell infiltrations are seen throughout the parasite body. ×200. (B) Calcareous bodies (arrows) and mild inflammatory cell infiltrations including lymphocytes and a few eosinophils, plasma cells, and polymorphonuclear cells are seen in the body of the cestode larva. ×400.
See this image and copyright information in PMC

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