Conservative management of neurocysticercosis in a patient with hematopoietic stem cell transplantation: a case report and review

Abstract

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is common in developing countries but its occurrence and management in allogeneic hematopoietic stem cell transplantation (HSCT) has not been reported previously, to our knowledge. We report the case of an immigrant female patient who underwent a matched-related allogeneic HSCT for acute lymphoblastic leukemia and was incidentally found to have a solitary viable neurocysticercosis lesion. However, despite severe immunosuppression, the size of the cyst did not increase. More importantly, restoration of the immune system did not induce significant inflammation or seizures. Subsequent follow-up demonstrated complete resolution of the neurocysticercosis lesion. Thus, in the setting of HSCT, an asymptomatic patient with a single neurocysticercosis lesion was successfully managed without the use of anthelmintics, steroids, or anti-epileptics.

Neurocysticercosis in A Hematopoietic Stem Cell Transplanted Patient

“…Anticonvulsant treatment was started with phenytoin and levetiracetam. Lumbar puncture revealed normal CSF analysis (red blood cells 2/mm 3 , white blood cells 2mm 3 , protein 33 mg/dL, and glucose 52 mg/dL). PCR for Taenia Solium was positive in cerebrospinal fluid, with no evidence of leukemic, or infection.…”

“…It is the most common parasitosis of the central nervous system (CNS). Infectious diseases are important complications of immunosuppressed patients, but NCC in transplant recipients is uncommon [3,4].…”

“…Increasing numbers of NCC are observed in the developed world, in areas with large migrant populations [1]. It is a condition that must always be considered in the differential diagnosis in transplant patients with CNS involvement and cystic lesions in neuroimaging [2][3][4]. The natural history of neurocysticercosis in the setting of transplant recipients is not well understood.…”

“…The natural history of neurocysticercosis in the setting of transplant recipients is not well understood. Few available reports have been published in the context of solid organ transplantation and one in HSCT in an adult woman [1,3,6,7]. The clinical manifestations of NCC are presented mainly by the parasite's mass effect and the host-immune response built up against the parasite.…”

“…Currently anticysticercal therapy has been marked by intense controversy. Recent data from endemic regions have led to the emergence of a growing body of literature to guide anthelmintic therapy in NCC, even in the setting of HSCT [3]. Many studies have documented that antiparasitic therapy results in death and resolution of viable cysts, but the clinical benefit of this treatment has been questioned.…”