Extraocular muscle cysticercosis mimicking idiopathic orbital inflammation: case report

Abstract

Presentation of one case of extraocular muscle enlargement caused by cysticercosis, its clinical, diagnostic and treatment aspects, and review of the literature on this theme. A female 38-year-old patient with extraocular muscle enlargement and a small cystic lesion at the superior rectus muscle insertion was treated with oral prednisone for almost one year, with a non-specific inflammation of right orbit diagnosis. There were important ocular motility restriction and pain. Computerized tomography disclosed a superior rectus muscle thickening with a small cystic and apparently empty lesion at the muscle's insertion. Excisional biopsy and histopathological study confirmed the clinical suspicion of cysticercosis. There was partial resolution of the restricted motility. Extraocular muscle cysticercosis is the most common site of this disease when involving the orbit. Oral albendazole and prednisone are efficient, but a long history of disease can lead to important residual ocular motility restriction.

What is a Low Frequency of the Disseminated Cysticercosis Suggests that Neurocysticercosis is Going to Disappear?

“…Combination of epilepsy, DCC, proptosis of the eyes, fever and arthralgia can be seen [8]. Disseminated cysticercosis can cause intravitreal lesions with exudative retinal detachment and bilateral extra ocular muscular damage at the same time [126] or afect only the brain, orbits, subcutaneous tissue [127,128] the eyes, tongue and spinal cord [127] or the tongue, eyes, face and scalp muscles [130], and an extensive involvement of both orbits [131]; face, scalp muscles, subconjuctival cysts in the eyes and cysticercotic encephalitis [132], cardiopulmonary cysticercosis plus proptosis of the eyes, extra ocular muscles of both orbits, extradural spinal, and cerebellar involvement [123] and other combinations such as: subarachnoid NCC, Brown syndrome, different extra ocular muscles involvement, mimicking idiopathic orbital inflammation, retina involvement , and canine tooth syndrome have been reported to the medical literature [119,[133][134][135][136][137][138].…”

Orbital Cisticercosis. A Challenger for Neurologists, Ophthalmologists, Neuro-Opthalmologists, and General Practitioners

“…Extraocular muscle cysticercosis is the most common site of this parasitic disease when involving the orbit. [224] In some series of patients with extraocular cysticercosis, the superior rectus muscle is the most commonly affected (33.3%) compared other involved muscles. [77] and clinical features usually are painful unilateral ptosis, inflammation of the upper eyelid and some restriction on down gaze.…”

“…Diagnosis is made by neuroimagen studies that show a welldefined ring-enhancing lesion in the superior rectus muscle. [14] Angotti-Neto et al [224] reported a 38-year-old Brazilian female patient with extraocular muscle enlargement and a small cystic lesion near the insertion of the superior rectus muscle treated with oral prednisone for almost one year due to a non-specific inflammation of right orbit diagnosis later confirmed as superior rectus muscle cysticercosis. That report illustrates the consequences of delayed antiparasitic treatment leading to leading to marked hypertrophy and limitation of infraduction and later an incomplete recovery.…”

Orbital Myositis

“…The host for C. cellulosae is the pig, and patients usually acquire the infection by eating undercooked pork. Imaging studies of orbital cysticercosis are characteristic, and the findings can differentiate of orbital cysticercosis from idiopathic orbital myositis (Angotti-Neto et al, 2007;Pushker et al, 2002;Rath et al, 2010) (Figure 15; Fujii et al, 2010;Takanashi et al, 2001). The ocular symptoms are often intolerable periocular pain that is markedly reduced following prednisolone plus cyclophosphamide.…”