Indian Journal of Medical Research

CLINICAL IMAGE
Year
: 2017  |  Volume : 146  |  Issue : 5  |  Page : 666--667

Lumpy body & starry sky: A case of disseminated cysticercosis


Jehangir S Sorabjee, Sumeet P Mirgh 
 Department of Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai 400 020, Maharashtra, India

Correspondence Address:
Jehangir S Sorabjee
Department of Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai 400 020, Maharashtra
India




How to cite this article:
Sorabjee JS, Mirgh SP. Lumpy body & starry sky: A case of disseminated cysticercosis.Indian J Med Res 2017;146:666-667


How to cite this URL:
Sorabjee JS, Mirgh SP. Lumpy body & starry sky: A case of disseminated cysticercosis. Indian J Med Res [serial online] 2017 [cited 2020 Nov 26 ];146:666-667
Available from: https://www.ijmr.org.in/text.asp?2017/146/5/666/226644


Full Text

A 29 yr old right-handed, vegetarian, immunocompetent male from Rajasthan was referred to the Emergency Department, Bombay Hospital Institute of Medical Sciences, Mumbai, India, in September 2014 with a six month history of headache and seizures. He denied any B symptoms. On examination, he had multiple painless subcutaneous lumps measuring 1 cm × 1 cm diameter better felt on the thighs and neck. He had impaired memory and judgement without any focal neurological deficit. There was no organomegaly or lymphadenopathy. Contrast enhanced computed tomography (CECT) brain scan revealed the classic 'starry-sky' appearance [Figure 1] suggestive of neurocysticercosis. Magnetic resonance imaging (MRI) brain with gadolinium contrast showed multiple cystic lesions with intracystic nodules suggestive of scolex [Figure 2] and [Figure 3]. His ELISA serology for cysticercal IgG antibody was strongly positive (>1:400). However, his stool examination for parasites was unremarkable. He was treated with antiepileptics (phenytoin 300 mg daily, levetiracetam 500 mg twice daily) and steroids (oral prednisolone 1 mg/kg). Albendazole was deferred in view of disseminated lesions with scolex suggesting 'activity'. He responded dramatically to steroids with improvement in neurological symptoms within 48 h. After first eight weeks, steroids were gradually tapered at 5 mg every two weeks. His headache subsided completely after two weeks and he did not have recurrence of seizures. At one-year follow up, he was stable without any new lesions [Figure 4] on 5 mg prednisolone alternate day.{Figure 1}{Figure 2}{Figure 3}{Figure 4}