Intramedullary parasite eggs, latent for three decades, mimicking acute transverse myelitis

Abstract

Background: Intramedullary parasitic infection is extremely uncommon, and clinical presentation of Brown-Sequard syndrome is even rarer.

Case presentation: The authors report a case involving a 57-year-old woman with Brown-Sequard syndrome, in whom magnetic resonance imaging and clinical and epidemiological features were similar to those of acute transverse myelitis. Myelotomy suggested inflammation caused by latent parasite eggs in the spinal cord. Antiparasitic and steroid therapies were administered postoperatively. To the author's knowledge, this is the first report to describe a surgical experience for Taenia solium eggs in the spinal cord.

Conclusion: Intramedullary parasitic infection is a diagnostic challenge that requires careful discrimination from other diseases. If parasite infection is suspected in a progressively deteriorating patient, myelotomy should be considered for rapid and accurate treatment.

Keywords: Acute transverse myelitis; Brown-Sequard syndrome; Central nervous system parasitic infections; Neurocysticercosis; Parasite eggs; Spinal cord neoplasm.

Fig. 1

Brain computed tomography of the patient

Fig. 2

Preoperative magnetic resonance images of the patient

Fig. 3

Intraoperative photography. Myelotomy T3–T5, open biopsy

Fig. 4

Photomicrographs of the histopathological specimen. Tissue from the ring-enhancing lesion revealed on magnetic resonance imaging was obtained by myelotomy and open biopsy. Tissue from the spinal cord exhibited glial tissue with diffuse infiltration of mononuclear inflammatory cells. At high magnification, round to oval-shape foreign bodies, presumed to be parasite eggs, were observed (hematoxylin and eosin stain, original magnification ×400)