Racemose neurocysticercosis simulating tuberculous meningitis. 2022

Prakash C Pandey, and Jayantee Kalita, and Jayesh Sardhara, and Neeraj Jain, and Pallavi Prasad
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar, Pradesh-226014, India.

We report a patient with racemose neurocysticercosis, highlighting the diagnostic and management issues. A 37-year-old male had headaches, fever, and seizures for 8 months. He had a positive tuberculin test, cerebrospinal fluid pleocytosis, and hydrocephalus and exudates on MRI. His symptoms rapidly resolved following antitubercular and prednisolone treatment. After 2 months, he was readmitted with headache and vomiting, and his brain MRI revealed communicating hydrocephalus with a cyst in the lateral ventricle and subarachnoid space, which was confirmed as neurocysticercosis on the third ventriculostomy. The patient was managed with dexamethasone and a ventriculoperitoneal shunt. This case highlights that meningitis symptoms, CSF pleocytosis, and positive tuberculin tests may not always suggest tubercular etiology.

UI MeSH Term Description Entries
D007964 Leukocytosis A transient increase in the number of leukocytes in a body fluid. Pleocytosis,Leukocytoses,Pleocytoses
D008297 Male Males
D011239 Prednisolone A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. Di-Adreson-F,Predate,Predonine,Di Adreson F,DiAdresonF
D003907 Dexamethasone An anti-inflammatory 9-fluoro-glucocorticoid. Hexadecadrol,Decaject,Decaject-L.A.,Decameth,Decaspray,Dexasone,Dexpak,Hexadrol,Maxidex,Methylfluorprednisolone,Millicorten,Oradexon,Decaject L.A.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006849 Hydrocephalus Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, INTRACRANIAL HYPERTENSION; HEADACHE; lethargy; URINARY INCONTINENCE; and ATAXIA. Communicating Hydrocephalus,Congenital Hydrocephalus,Obstructive Hydrocephalus,Post-Traumatic Hydrocephalus,Aqueductal Stenosis,Cerebral Ventriculomegaly,Fetal Cerebral Ventriculomegaly,Hydrocephalus Ex-Vacuo,Hydrocephaly,Aqueductal Stenoses,Cerebral Ventriculomegalies,Cerebral Ventriculomegalies, Fetal,Cerebral Ventriculomegaly, Fetal,Fetal Cerebral Ventriculomegalies,Hydrocephalus Ex Vacuo,Hydrocephalus Ex-Vacuos,Hydrocephalus, Communicating,Hydrocephalus, Congenital,Hydrocephalus, Obstructive,Hydrocephalus, Post-Traumatic,Post Traumatic Hydrocephalus,Stenoses, Aqueductal,Stenosis, Aqueductal,Ventriculomegalies, Cerebral,Ventriculomegalies, Fetal Cerebral,Ventriculomegaly, Cerebral,Ventriculomegaly, Fetal Cerebral
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014390 Tuberculosis, Meningeal A form of bacterial meningitis caused by MYCOBACTERIUM TUBERCULOSIS or rarely MYCOBACTERIUM BOVIS. The organism seeds the meninges and forms microtuberculomas which subsequently rupture. The clinical course tends to be subacute, with progressions occurring over a period of several days or longer. Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA. The illness may occur in immunocompetent individuals or as an OPPORTUNISTIC INFECTION in the ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunodeficiency syndromes. (From Adams et al., Principles of Neurology, 6th ed, pp717-9) Meningitis, Tuberculous,TB Meningitis,Tubercular Meningitis,Tuberculosis Meningitis,Tuberculous Hypertrophic Pachymeningitis,Hypertrophic Pachymeningitides, Tuberculous,Hypertrophic Pachymeningitis, Tuberculous,Meningeal Tuberculoses,Meningeal Tuberculosis,Meningitides, Tubercular,Meningitides, Tuberculosis,Meningitides, Tuberculous,Meningitis, Tubercular,Meningitis, Tuberculosis,Pachymeningitides, Tuberculous Hypertrophic,Pachymeningitis, Tuberculous Hypertrophic,TB Meningitides,Tubercular Meningitides,Tuberculoses, Meningeal,Tuberculosis Meningitides,Tuberculous Hypertrophic Pachymeningitides,Tuberculous Meningitides,Tuberculous Meningitis
D020019 Neurocysticercosis Infection of the brain, spinal cord, or perimeningeal structures with the larval forms of the genus TAENIA (primarily T. solium in humans). Lesions formed by the organism are referred to as cysticerci. The infection may be subacute or chronic, and the severity of symptoms depends on the severity of the host immune response and the location and number of lesions. SEIZURES represent the most common clinical manifestation although focal neurologic deficits may occur. (From Joynt, Clinical Neurology, 1998, Ch27, pp46-50) CNS Cysticercosis,Central Nervous System Cysticercosis,Cerebral Coenurosis,Cerebral Cysticercosis,Cysticercosis, Brain,Cysticercosis, Central Nervous System,Neurocoenurosis,Brain Cysticercosis,CNS Cysticercoses,Cerebral Coenuroses,Cerebral Cysticercoses,Coenurosis, Cerebral,Cysticercosis, CNS,Cysticercosis, Cerebral,Neurocoenuroses,Neurocysticercoses

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