Doctors in Spain recently identified a case of neurocysticercosis in a 60-year-old man who was initially misdiagnosed with metastatic brain cancer. According to a report published in the journal Emerging Infectious Diseases, the patient’s brain lesions were actually cysts caused by the pork tapeworm, Taenia solium. The man recovered following antiparasitic treatment and steroid therapy, highlighting the diagnostic challenges of the parasite in nonendemic regions.
How does a tapeworm end up in the brain?
The pork tapeworm, Taenia solium, typically enters the human body through the ingestion of undercooked pork containing larval cysts. Once in the gut, these larvae mature into adult tapeworms, which produce eggs that are expelled through feces. If these eggs are ingested by another person—often through contaminated water or food—they do not develop into adult worms. Instead, they form cysts in various tissues, including the brain, a condition known as neurocysticercosis, according to the medical team’s report.
Neurocysticercosis is a leading global cause of seizures acquired later in life. While it is considered a neglected tropical disease in poorer regions, it remains rare in high-income nations like the United States and Spain.
Why was the case initially misdiagnosed?
The patient presented with worsening headaches and behavioral changes, symptoms that led doctors to suspect brain cancer. A CT scan revealed lesions that closely mimicked the appearance of metastatic tumors. Consequently, the man was treated with dexamethasone, a steroid used to manage brain cancer symptoms, which led to a rapid improvement in his condition. Further testing, including an MRI and antibody screening, was required to confirm the presence of T. solium rather than malignancy.
Could this happen in nonendemic regions?
Autochthonous transmission—or local infection—is described as “exceedingly rare” by the treating physicians. In this instance, the patient had no history of travel to areas where the parasite is endemic. However, his work in construction involved sharing meals and facilities with migrant workers from regions where the tapeworm is more common. Doctors suggest this likely led to an initial gut infection, followed by the patient re-infecting himself with his own waste. The case serves as a clinical reminder that medical professionals should consider neurocysticercosis as a potential diagnosis for brain lesions, even in patients without travel history to high-risk areas.
Pro Tips for Identifying Neurocysticercosis
- Consider the history: Look for potential exposure to fecal-oral transmission, even in domestic settings.
- Use advanced imaging: While CT scans are useful, MRI scans are often necessary to distinguish between parasitic cysts and metastatic lesions.
- Steroid response: Be aware that patients with neurocysticercosis may show temporary improvement on steroids because the medication reduces the inflammation caused by the cysts.
Frequently Asked Questions
Is neurocysticercosis fatal?
According to the report in Emerging Infectious Diseases, while the condition can cause life-threatening inflammation and intracranial pressure, it is generally treatable and rarely fatal.
How is the infection treated?
Treatment typically involves antiparasitic medication to eliminate the parasite and steroids like dexamethasone to manage the inflammation that occurs as the cysts die.
Can you catch this from eating pork?
Eating undercooked, infected pork can lead to an adult tapeworm infection in the gut. However, neurocysticercosis occurs when a person ingests the eggs of the tapeworm, usually through contact with contaminated feces.
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