SUBCUTANEOUS CYSTICERCOSIS: ROLE OF HIGH RESOLUTION ULTRASOUND IN DIAGNOSIS

Abstract

Background: Though the commonest site of extraintestinal infestation with Taenia solium is brain, Subcutaneous cysticercosis is fairly common in asia. The advent of high resolution ultrasound, FNAC, and a heightened clinician awareness of the existence of isolated soft tissue cysticerci has probably supplanted the need for surgical interven- tion and excision biopsy in asymptomatic subcutaneous cysts, as cysts have high rate of spontaneous resolution.

Objectives: - To observe role of high resolution ultrasound in diagnosis and need of surgical intervention in treat- ment of subcutaneous cysticercosis.

Materials & Methods: retrospective study of seven cases of extraneural cysticercosis, all involving the subcutane- ous tissues or muscles over the arms and torso. Either high resolution ultrasound, FNAC, or excision biopsy, or a combination of these were used to arrive at a diagnosis. All patients were followed up with serial ultrasounds. All patients received oral nitazoxanide for autoinfection. Surgical excision was resorted to in two patients, in whom it was possible to obtain a histopathologic diagnosis.

Results: of the seven cases of subcutaneous cysticercosis all have rural background, most of the patients (6) were vegetarian and one was non vegetarian. Age & gender of patient, size and duration of lesion were insignificant in establishing the diagnosis. High resolution ultrasound was highly significant in establishing the diagnosis over FNAC and histopathology. Five of the cases resolved spontaneously and surgical intervention was required only in two cases.

Conclusions: With heightened clinician awareness of the existence of isolated subcutaneous cysticercosis in patients with close animal contact, and the widespread availability of high resolution ultrasound and FNAC, subcutaneous cysticercosis can be diagnosed readily. Surgery can be avoided in the great majority of these patients, as the cysts mostly resolve on their own, and do not require any specific treatment. Identification and treatment of autoinfec- tion, and of another source of infection in the household is equally important.