Abstract Details

Title Limitations of Using Radiological Imaging to Determine Treatment Success in Neurocysticercosis

Topic Infectious Disease

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 10-009

Objective Not Applicable

Background Neurocysticercosis (NCC) is a helminthic infection of the central nervous system caused by larval cysts of Taenia Solium. Although an undetectable T. solium antigen is used as confirmation of cure in cases of extraparenchymal (e.g., subarachnoid and intraventricular) disease, limited information exists regarding the evolution of radiological findings throughout treatment.

Design/Methods We reviewed medical records of 6 patients with successfully treated extraparenchymal NCC seen at University of California San Francisco between 2015 and 2021. Treatment success was defined as undetectable T. solium antigen and TsolR13 PCR from CSF after anti-helminthic therapy.

Results

A 44-year-old Latino man presented with 1 month of progressive headache, nausea, and vomiting. Brain MRI demonstrated multiple cystic lesions in the fourth ventricle and prepontine cisterns. T. solium antigen and TsolR13 qPCR were positive from CSF. He was started on albendazole with a dexamethasone taper, although treatment was complicated by poor adherence due to persistent nausea and emesis. After 6 months of stop-and-start therapy, the patient stopped treatment with no improvement in nausea and emesis. An MRI after 3 months off treatment showed increased enhancement of a cystic lesion with worsened edema of the cerebellum and brainstem. He completed another 9 months of treatment until repeat T. solium antigen and TsolR13 qPCR from CSF were undetectable. Repeat MRI after treatment completion demonstrated stable to smaller cystic lesions with persistent enhancement. The patient has continued to do well with no new symptoms.

We reviewed 5 similar cases of successfully treated extraparenchymal NCC. In all cases, anti-helminthic therapy was stopped when T. solium antigen was undetectable. Patients did well clinically despite radiological imaging showing persistent cystic lesions/enhancement.

Conclusions Patients with successfully treated NCC frequently have persistent abnormalities on MRI. While imaging may be useful to assess treatment response, residual post-treatment findings are common and do not necessitate ongoing anti-helminthic therapy.

Authors/Disclosures
Jasleen K. Bains, Undergraduate Student PRESENTER	Miss Bains has nothing to disclose.
Meg Wilson (University of California, San Francisco)	No disclosure on file
Elana Farrell, BA	Ms. Farrell has nothing to disclose.
Arantxa N. Sanchez Boluarte, MD, MPH (UNIVERSIDAD PERUANA CAYETANO HEREDIA)	Dr. Sanchez Boluarte has received research support from NIH Fogarty International Center .
Soonmee Cha, MD	Dr. Cha has nothing to disclose.
Felicia Chow, MD (Zuckerberg San Francisco General Hospital)	Dr. Chow has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Medicolegal consulting. The institution of Dr. Chow has received research support from NIH.

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