Disseminated Cysticercosis in Rwanda—Case Report of a Patient Presenting with Difficulty with Walking and Skin Nodules

• Main Authors: J. Tuan, L. Kailani, P. Ngabitsinze, S. Umuganwa, F. Munyaneza, E. Musoni, A. L. Canales, M. Nkeshimana
• Format: Article
• Language: English
• Published: Rwanda Biomedical Centre (RBC)/Rwanda Health Communication Center 2020-03-01
• Series: Rwanda Medical Journal
• Subjects: cysticercosis; neurocysticercosis; taenia solium; rwanda
• Online Access: https://www.rwandamedicaljournal.org/uploads/1/2/2/1/122149944/cr.19.19.pdf

Human cysticercosis is a parasitic disease caused by larval cysts of the Taenia solium tapeworm. The pathogenesis of disseminated cysticercosis involves migration of Taenia solium embryos from the hepatoportal system to organs and tissues in the body. Symptoms may range anywhere from neurologic sequelae such as seizures, to skin manifestations such as subcutaneous nodules [1-2]. Disseminated cysticercosis is a rare complication of cysticercosis, and globally, fewer than 50 cases of disseminated cysticercosis are documented [1-3]. Human cysticercosis is endemic to Rwanda with a seroprevalence of 7% [4]. An increased prevalence of cysticercosis has been noted among epileptic persons in the southern province of Rwanda [5]. We describe a 46-year-old Rwandan woman from Kamonyi District, in the southern province of Rwanda, who presented with a two-week history of bilateral lower limb weakness, causing difficulty walking. She had associated fevers and headache. She was febrile and tachycardic, with decreased lower extremity strength and subcutaneous nodules on her trunk and extremities. Laboratory data demonstrated leukocytosis with neutrophilic predominance and mild eosinophilia. Excisional biopsy of a subcutaneous nodule revealed a cyst containing a protoscolex with suckers, ramifying cistern, and calcareous bodies; brain magnetic resonance imaging demonstrated diffuse, cystic cerebral, cerebellar, and soft tissue lesions—consistent with disseminated cysticercosis. The patient received a fourteen-day course of albendazole and prednisolone, and afterwards, noted restored ability to walk independently. In this case, prompt diagnosis and treatment of disseminated cysticercosis led to dramatic clinical improvement.