ID Fellows Cup Question 4

Correct Answer: Glucocorticoids

This patient likely has viable intraparenchymal neurocysticercosis (NCC). Although albendazole combined with praziquantel is the recommended therapy for patients with more than 2 parenchymal cysts, corticosteroid therapy should be started prior to anti-parasitic therapy to reduce the inflammatory response to dying organisms. The patient’s geographical origin places him at potentially increased risk of exposure to Taenia solium. However, in addition to country of origin, questions related to access to water, consumption of undercooked pork, close contacts who might also have had a similar presentation or infection, or contact with pigs should be asked. The imaging findings seen in this patient are consistent with NCC and can be confirmed with serologic testing (enzyme-linked immunotransfer blot). Given multiple lesions with evidence of surrounding edema, his disease would be classified as viable parenchymal.

Distractor answer choices

  • Radiation therapy is not a treatment for cerebral edema in immunocompetent patients with viable intraparenchymal NCC.
  • As mentioned above, albendazole monotherapy would be indicated with 2 or fewer parenchymal cysts while combination albendazole with praziquantel should be used for patients with more than 2.
  • Trimethoprim-sulfamethoxazole would be indicated in the treatment of CNS toxoplasmosis.

Written by Nico Herrera, Edited by Prathit Kulkarni

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