Musculoskeletal Cysticercosis

Lavina Desai*, Ira Shah**
* Seth G S Medical College, Mumbai, India, and **Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India.

Address for Correspondence: Lavina Desai, Seth G S Medical College, India. Email: lavinadesai16@gmail.com


Clinical Problem:
A 23 year old female was referred to us in April 2016 with right shoulder swelling for 3 months. In January 2015 she had fever and right axillary lymphadenopathy and was diagnosed to have right forearm cysticercosis as her MRI of the right shoulder showed ruptured cysticercal granuloma in the distal triceps. MRI brain at that time was normal. She was treated with albendazole at that time. The duration of albendazole is not known. Her brother was also diagnosed with neurocysticercosis in January 2016. The family used to eat a vegetarian diet. In January 2016, due to a repeat swelling in right shoulder, immunological workup was done. Her serum IgG was 952 gm/dl, IgM was 248 gm/dl and IgA was 309 gm/dl. At presentation in April 2016 she had a non-tender right upper arm swelling. MRI of the right shoulder showed a large loculated abscess involving proximal triceps (size 8.8x2.7x3.5 cm) and proximal tibia (figure 1). The fluid in the distal triceps that was seen in the Jan 2015 imaging had resolved. She was restarted on albendazole and advised to do Cysticercus Elisa IgM and IgG, stool examination and further immunodeficiency workup in form of HIV and lymphocyte subset analysis. She was also advised surgical excision of the abscess.

Figure 1: MRI of right shoulder shows large loculated abscess involving proximal triceps and proximal tibia

How should musculoskeletal cysticercosis be treated?