Patient 1: A 64-year-old Cape Verdean woman presented with headaches, seizures, and multiple subarachnoid cysts on brain MRI. She was treated with a prolonged course of albendazole and prednisone with recurrent disease following prednisone taper.  Methotrexate was tried but resulted in ulcerative stomatitis and leukopenia. Prednisone was resumed without antiparasitic therapy and was tapered slowly with resolution of her symptoms and MRI findings.

Patient 2: A 48-year-old Guatemalan man presented with headaches and multiple cysts in the pre-pontine and lumbar cisterns. He was treated with albendazole and dexamethasone for 6 months, complicated by lumbar vertebral fracture. Because of persistent inflammation on his brain MRI, he was transitioned to methotrexate with clinical stability.

Patient 3: A 43-year-old Cape Verdean man presented with headache and parenchymal cysts on brain MRI. He was treated with praziquantel, albendazole, and dexamethasone and was re-treated several months later because of persistent perilesional edema. Because of ongoing perilesional edema on high-dose prednisone, he initiated methotrexate. Perilesional edema persisted, and he was started on adalimumab with clinical and radiographic resolution. 

We describe 3 cases of persistent neurocysticercosis-associated inflammation that highlight both the efficacy and complications of SSAs use in neurocysticercosis. Our series emphasizes the need for further study on the use of SSAs in the treatment of neurocysticercosis-related inflammation.