Second Case of Neurocysticercosis in a Patient With Liver Transplantation (First Case in Spain): A Case Report

• Published in: Transplantation proceedings Vol. 39; no. 7; pp. 2454 - 2457
• Main Authors: Barra Valencia, V, Moreno Elola-Olaso, A, Fundora Suárez, Y, Meneu Díaz, J.C, Jiménez de los Galanes, S.F, Pérez Saborido, B, San Juan, R, Ruiz Giménez, J, Abradelo Usera, M, Donat Garrido, M, Gimeno Calvo, A, Hernández Pérez, M.C, Jiménez Romero, C, Moreno González, E
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2007; Elsevier Science
• Subjects: Animals; Biological and medical sciences; Brain - diagnostic imaging; Cysticercosis; Diseases caused by cestodes; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Helminthic diseases; Humans; Infectious diseases; Liver Failure - parasitology; Liver Failure - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Neurocysticercosis - diagnostic imaging; Neurocysticercosis - surgery; Parasitic diseases; Spain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Taenia - isolation & purification; Tissue, organ and graft immunology; Tomography, X-Ray Computed; Treatment Outcome; Europe; Spain; Human; Cysticercosis; Digestive system; Liver; Central nervous system; Patient; Neurocysticercosis; Parasitosis; Homotransplantation; Helminthiasis; Cestode disease; Infection; Case study; Medicine; Treatment; Surgery; Graft; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.07.049

Abstract Background Neurocysticercosis (NCC) is a disorder caused by the Taenia solium larva. It is the most common parasitosis of the central nervous system (CNS). Its distribution is universal, but it is endemic in many developing countries and in the third world. In Spain most patients come from countries where the condition is endemic. However, sporadic cases occur among the population of rural regions. NCC in transplant recipients is uncommon. One renal transplant recipient developed NCC but responded to treatment with praziquantel. Recently, it has been reported to complicate a liver transplantation. Case report The patient was a 49-year-old Ecuatorian man who received a cadaveric donor liver graft in June 2001 due to acute liver failure induced by toadstool and was under treatment with FK506. In January 2006, the patient presented with a generalized onset of a tonic-clonic seizure for 1 minute without sphincter incontinence, headache, fever, or previous brain trauma. Neurological evaluation did not show evidence of organic brain dysfunction. The neuroimaging findings (brain) computed tomography scan, magnetic resonance imaging were compatible with NCC: many cystic lesions intra- and extraparenchymatous with a scolex visible in three of them. Serology for cysticercosis in plasma was initially indeterminate but positive afterward. The patient was treated with anticonvulsivants (valproic acid) and albendazole. Systemic steroids were added in order to reduce the edema produced upon death of the cyst. Treatment lasted 3 weeks and it was completed without complications or neurological symptoms. Liver function was not affected. One year later the patient remained asymptomatic. Conclusion NCC is a condition that must be included in the differential diagnosis of patients with CNS involvement and cystic lesions on neuroimaging investigations in transplant recipients, especially patients originating from or traveling to endemic areas. First-line therapy for active cysts includes antiparasitic drugs (albendazole or praziquantel) as well as steroids and anticonvulsivants. In our patient, this therapy was effective.