Abstract Details

Title A Solitary Enhancing Right Parietal Lesion Mimicking High-grade Glioma: An Unusual Presentation of Neurocysticercosis in the USA

Topic Infectious Disease

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-006

Objective NA

Background Neurocysticercosis-NCC caused by the larval stage of Taenia solium, is a leading cause of acquired epilepsy worldwide. Although relatively uncommon in the United States, its incidence is rising. In non-endemic regions, NCC poses diagnostic challenges, often mimicking neoplastic, abscess, or inflammatory lesions on imaging. We report a rare case of right parietal NCC masquerading as a high-grade glioma, confirmed pathologically by CDC.

Design/Methods NA

Results

A 42-year-old male with no prior medical history presented with sudden-onset left arm clumsiness followed by a generalized tonic–clonic seizure. A similar episode with transient left arm weakness had occurred three months earlier. Neurological examination was normal. MRI revealed a 2.2 × 2.0 × 1.9 cm peripherally enhancing right parietal lesion abutting the dura with cystic and non-enhancing solid components, raising concern for high-grade glioma versus abscess.

He was started on dexamethasone and levetiracetam. Cancer screening showed no malignancy. Following tumor board review, the patient underwent gross total resection under 5-ALA guidance. Intraoperative frozen section suggested a glial neoplasm. However, final pathology demonstrated necrotic parasitic structures with cysticercus wall, calcareous corpuscles, but without scolex, consistent with Taenia solium, confirming NCC verified by the Centers for Disease Control, CDC-consultation. Histology revealed polyclonal plasma cells with an elevated IgG4/IgG ratio >40%, indicating chronic immune activation; lymphoma and plasma cell neoplasm were excluded. The patient recovered fully, with consideration of antiparasitic therapy.

Conclusions Our case highlights the atypical presentation of a solitary ring-enhancing brain lesion with elevated IgG4/IgG ratio, of NCC and its potential to mimic neoplasm or abscess, even in immunocompetent patients at non-endemic areas with NCC risk factors (endemic origin or exposure). Conversely, a brain tumor initially was diagnosed as NCC based on imaging and positive serology has been reported—emphasizing the need for diagnostic vigilance and comprehensive evaluation to avoid unnecessary oncologic treatment and ensure appropriate management.

Authors/Disclosures
Shiv K. Jha, MBBS PRESENTER	Dr. Jha has nothing to disclose.
Seyhmus Aydemir, MD (Montefiore Medical Center)	Dr. Aydemir has nothing to disclose.
Monika Pandit, MBBS	Dr. Pandit has nothing to disclose.
Benjamin Himes, MD, PhD	Dr. Himes has nothing to disclose.
Roger Fecher, MD, PhD	Dr. Fecher has nothing to disclose.
Adilia M. Hormigo, MD, PhD (Albert Einstein College of Medicine)	Dr. Hormigo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TargTex.

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