“Looks Can Be Deceiving”: Atypical Brain Metastases Mimicking Neurocysticercosis, a Case Report and a Review of the Literature - Abstract
Background: The ingestion of eggs of Taenia solium (also called pork tapeworm) determines infestation of the central nervous system (CNS) by the larval form of parasites with the formation of multiple cysts. The main diagnostic criteria for neurocysticercosis is the evidence of cystic lesions showing the presence of scolex on neuroimaging studies, typically MRI) or CT. Neurocysticercosis represents the most common parasitosis of the nervous system in the developing world, being also the leading cause of acquired epilepsy. Sporadic cases of neurocysticercosis are reported in Italy and the vast majority of patients are infected abroad. We hereby describe the case of a patient initially diagnosed with neurocysticercosis because of multiple cystic intracranial lesions, which were finally identified as brain metastases of primary lung adenocarcinoma. Case presentation: A 67-year-old Italian-born Caucasian woman with a subacute history of gait disorders was admitted to the Infectious Diseases Unit of the Hospital of Pisa in Italy in February 2018, with a suspected diagnosis of neurocysticercosis. MRI showed multiple supra- and infratentorial cystic lesions, some of which had a “dot” within the cyst, suggesting the presence of scolex, which would have been an absolute diagnostic criterion for neurocysticercosis. Serological tests for cysticercosis were negative. This result, together with the negative epidemiology, the number and dimensions of the cysts, and a study of the literature, prompted thoracic TAC-PET imaging, because of the suspect of metastatic lung cancer. CT scan showed a spiculated nodule in the latero-basal segment of the left lower lobe and numerous other solid pulmonary nodules. A fine needle biopsy of the main lesion confirmed the diagnosis of adenocarcinoma (NSCLC). After an onco-pneumological consultancy, it was decided not to start antineoplastic therapy and the patient was moved into a day hospice, where she
expired about one month after her admission to our ward. Conclusions” This case illustrates the importance of the differential diagnostic approach to peculiar radiological features that on first examination might appear suggestive of neurocysticercosis. The unusual clinical presentation of this case and the radiological aspect of brain lesions delayed our patient’s diagnosis of primary cancer. Lack of perilesional edema, cystic appearance and the supposed identification of scolex within cysts led, at first, to the diagnosis of neurocysticercosis. Despite the absence of constitutional symptoms, the possibility of malignancy should be considered in the differential diagnosis of brain cystic lesions.