|Year : 2017 | Volume
| Issue : 2 | Page : 37-38
Retinal Cysticerci- A Contraindication for Albendazole Therapy
Sanjeev Kumar1, Ashok Kumar2, Abhay Ranjan1, Bishwanth Kumar1
1 Asst. Professor, Department of Neurology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Professor and HOD, Department of Neurology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
|Date of Web Publication||11-Dec-2020|
Assistant Professor, Department of Neurology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna -14, Bihar
Source of Support: None, Conflict of Interest: None
Neurocysticercosis is the most common parasitic disease of the nervous system especially, in the Indian sub-continent. The disease manifests when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. Retinal cysticercosis is a dangerous situation where vision will be compromised. Surgical excision is the preferred treatment in place of anti-parasitic medication. We are reporting a case of multiple cysticerci in the brain parenchyma and a single cyst in subretinal space to highlight the association and treatment decision to prevent visual loss.
Keywords: Albendazole, Retinal Cysticerci, Taenia solium.
|How to cite this article:|
Kumar S, Kumar A, Ranjan A, Kumar B. Retinal Cysticerci- A Contraindication for Albendazole Therapy. J Indira Gandhi Inst Med Sci 2017;3:37-8
|How to cite this URL:|
Kumar S, Kumar A, Ranjan A, Kumar B. Retinal Cysticerci- A Contraindication for Albendazole Therapy. J Indira Gandhi Inst Med Sci [serial online] 2017 [cited 2021 Dec 7];3:37-8. Available from: http://www.jigims.co.in/text.asp?2017/3/2/37/303144
| Introduction|| |
Cysticercal infection is one of the common parasitic infections in India. It is caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium. Cysticercosis is acquired by ingestion of faecally contaminated food, water or vegetables containing ova of T.solium. Disseminated neurocysticercosis (NCC) is a rare presentation. Cysticerci are most often located in subcutaneous and intramuscular tissues, followed by the brain and then the eye. The Central Nervous System (CNS) is involved in 60-90% of patients (i.e., NCC). Ophthalmic cysticercosis occurs only in 1-3% of all infections, even though T. solium is the most common intraorbital parasite.
Intraocular cysts are most commonly found in the vitreous humour as freely floating or in the sub retinal space, where retinal detachment is an unfortunate consequence. Visual disturbance is dependent upon the degree of damage to retinal tissue or the development of chronic uveitis.
| Case Summary|| |
A 35-year-old man, who was a farmer, presented with a history of headache & generalized tonic-clonic seizure. He was diagnosed neurocysticercosis and was treated albendazole. After second dose of albendazole, there was painful gradual loss of vision in the right eye. Within 10-12 days he lost his vision completely from right eye. He presented to us with loss of vision from right eye. At the time of admission, he had only perception of light and fundus examination revealed a hazy vitreous. His neurological examination was completely normal.
His haemogram, liver and renal function tests were normal. Enzyme-linked immunosorbent assay (ELISA) for HIV was negative. Magnetic resonance imaging (MRI) showed ?starry sky appearance”[Figure 1]A,[Figure 1]B,[Figure 1]C,[Figure 1]D,[Figure 1]E,[Figure 1]F. Ocular B-scan showed right sub retinal cystic lesion in mid- vitreous with an associated posterior vitreous detachment (PVD) [Figure 2]A,[Figure 2]B,[Figure 2]C,[Figure 2]D.
|Figure 1: MRI of brain showed starry sky appearance. T2 flair and C-E T2 image showed multiple cystic lesion with perilesional edema. T1 contrast image showed no contrast uptake.|
Click here to view
|Figure 2: Fundus photograph of eye(A-B) showed hazy vitreous in right eye. Ocular B-Scan (C-D) Showed retinal Cysticerci in right eye with scolex.|
Click here to view
Patient was planned for pars planna vitrectomy, but he refused to receive surgical treatment. He received five doses of I.V methylprednisolone (total 5 Gm) and showed significant improvement in vision as he was able to perceive hand movements and after one month he was able to count finger at 2 metre distance.
| Discussion|| |
Dissemination of T. Solium, in human is caused by autoinfection of hexacanth larvae. These larvae enter via the hepato-portal system into the tissues and organs of the body after invading intestine. The most commonly affected structures are the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, liver and occasionally the heart.
Definite diagnosis of neurocysticercosis require either one absolute criterion or a combination of two major criteria, one minor criterion, and one epidemiologic criterion as described by Del Brutto et al. Our patient has visualization of scolex on B-Scan of right eye with MRI-Brain highly suggestive of neurocysticercosis. He also belonged to epidemiological endemic area.
In Ocular cysticercosis, most studies in Western Europe documented the posterior segment of the globe as the most common site of occurrence whereas in previous Indian studies they are documented to be found in the ocular adnexa.,, Kruger-Leite et al,found that the most common site was the subretinal space( 35%)followed by the vitreous and the subconjunctival space(22% each). The anterior segment and the orbit accounted for 5% and 1% of cases respectively. Cysticerci is brought via the posterior cilliary arteries to the sub retinal space usually in the region of the posterior pole. Retinal pigment epithelial disturbances, retinal detachment, retinal oedema, intraretinal haemorrhage, and vascular sheathing are known to occur in intraocular cysticercosis. Pushker et al. found that only 2 out of 20 patients with brain cysticerci had coexisting ocular cysticercosis.
We are reporting this case only to highlight that- (a) retinal cysticerci is one of contraindication of albendazole therapy and (b) before starting albendazole we must do B-Scan to rule out ocular cysticercosis, as our patient experienced total loss of vision after Aldendazole therapy, due to inflammatory changes in retina as well as in the vitreous and also caused retinal detachment.
| References|| |
Rahalkar MD, Shetty DD, Kelkar AB, Kelkar AA, Kinare AS, Ambardekar ST. The many faces of cysticercosis. Clin Radiol 2000;55:668-74.
García HH, Gonzalez AE, Evans CA, Gilman RH; Cysticercosis Working Group in Peru. Taenia solium cysticercosis. Lancet. 2003;16;362:547-56.
Del Brutto OH, Rajshekhar V, White AC Jr,Tsang VC, Nash TE, Takayanagui OM et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001 ;24;57:177-83.
Sekhar GC, Lemke BN. Orbital cysticercosis. Ophthalmology 1997;104:1599-604.
Malik SR, Gupta AK, Choudhry S. Ocular cysticercosis. AmJ Ophthalmol 1968;66:1168-71.
Reddy PS, Satyendran OM. Ocular cysticercosis. Am J Ophthalmol 1964; 57:664-6.
Kruger-Leite E, Jalkh AE, Quiroz H, Schepens CL. Intraocular cysticercosis. Am J Ophthalmol 1985;99:252-7.
Manschot WA. Intraocular cysticercosis. Arch Ophthalmol 1968; 80:772-4.
Pushker N, Bajaj MS, Chandra M, Neena. Ocular and orbital cysticercosis. Acta Opthalmol Scand 2001;79: 408-13.
[Figure 1], [Figure 2]