Abstract Details

Title Racemose Neurocysticercosis Complicated with Hydrocephalus and Immune Reconstitution Inflammatory Syndrome. Key Findings in a Challenging Case

Topic Infectious Disease

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

Poster/Presentation
Number 3-011

Objective Here we present the case of a 33-year-old male patient with a history of Human Immunodeficiency Virus (HIV) infection in his first 3 months of good adherence to antiretroviral therapy, who presented to the emergency department due to a week of headache, behavioural changes, fluctuating non-fluent aphasia, a first episode of seizures and altered awareness. Infectious and non-infectious conditions were considered. A diagnosis of Racemose Neurocysticercosis complicated with hydrocephalus and superimposed on Immune Reconstitution Inflammatory Syndrome (IRIS) was proposed.

Background Cysticercosis is recognized as a neglected tropical disease. Neurocysticercosis is considered a foodborne parasite of greatest global concern. Its racemose presentation refers to the presence of clustered cysts following a pattern of a bunch of grapes. HIV patients carrying Taenia solium are susceptible to developing IRIS during the initial phases of antiretroviral therapy.

Design/Methods Detailed medical history, thorough physical examination, systemic screening, neuroimaging, cerebrospinal fluid (CSF) and cerebral biopsy were obtained.

Results A viral load of 46 copies and a CD4 T lymphocyte count of 246 were documented. CSF showed hypoglycorrhachia (Ratio 0.43) and hyperproteinorrachia (291 mg/dl). Molecular studies were negative. Magnetic Resonance Imaging with gadolinium revealed ventriculomegaly, asymmetric increased signal in bilateral white matter, and abundant enhancing racemose lesions in the third and fourth ventricles, and in the lateral sulcus on the left side. Surgical intervention was considered high-risk. The clinical and imaging response to treatment with dexamethasone, albendazole and continued antiretroviral therapy supported the suspected diagnosis. The report of brain biopsy immunohistochemical studies is pending.

Conclusions While there is a high diagnostic suspicion of opportunistic neuroinfectious in immunocompromised patients with acute neurological symptoms, establishing the most likely microorganism causing the symptoms often poses particular challenges. The early suspicion of Racemose Neurocysticercosis in a patient with signs of hydrocephalus and superimposed IRIS was decisive for the timely initiation of an appropriate therapeutic approach.

Authors/Disclosures
Estefania Rojo-Bustamante, MD, PhD PRESENTER	Dr. Rojo-Bustamante has nothing to disclose.
Carlos J. Perdomo, Sr., MD	Dr. Perdomo has nothing to disclose.
Karen M. Ordonez, MD	Dr. Ordonez has nothing to disclose.
Luis F. Martinez, Sr., MD	Dr. Martinez has nothing to disclose.
Jhon D. Ramírez-Diossa, MD	Dr. Ramírez-Diossa has nothing to disclose.

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