Isolated Muscular Cysticercosis: A Rare Pseudotumor and Diagnostic Challenge, can It be treated Nonoperatively? A Report of Two Cases and Review of Literature

Abstract

Cysticercosis, an infection with the larval form of pork tape worm, Taenia solium, commonly presents with multiple muscular cysts or CNS involvement. Due to vague clinical presentation and unfamiliarity of clinicians with this entity, it is difficult to diagnosis when seen as an isolated cyst. Traditional treatment is surgical excision and a course of deworming agents. We present two cases of isolated muscular cysticercosis diagnosed by USG, MRI and blood tests, who responded successfully to oral medication without need of operative intervention. Case reports:A 45-year-old male patient had a tender 2 week swelling of 4 x 5 cm on medial right proximal calf. A 26-year male presented with discomfort and diffuse 6 cm swelling at inner left forearm. In both ultrasound showed characteristic hypoechoic cyst with hyperechoic scolex, and MRI revealed isolated cyst surrounded by inflamed muscles. FNAC confirmed cysticercosis, and the patient responded to oral albendazole (3 weeks) with oral steroids (2 weeks). Conclusion:Although rare, possibility of isolated muscular cysticercosis should always be considered in any small musculoskeletal soft tissue swelling presenting with nonspecific clinical findings. Both our patients responded to medical therapy and were disease free, as confirmed at 3 months by follow-up MRI. These cysts can be confidently diagnosed on the basis of ultrasound and MRI, and can be very well-treated nonsurgically with an oral drug regimen consisting of albendazole and steroid.

Isolated intramuscular cysticercosis of the forearm masquerading as malignancy

“…Without keeping this differential diagnosis in mind and giving appropriate weight to the history, it is difficult to have a clinical suspicion of cysticercosis. Lipomas, neurofibromas, epidermoid cysts, pyomyositis and tuberculous lymphadenitis are some of the other common presentations that might show similarly 10…”

An isolated subcutaneous paraspinal pseudo-tumor—more to it than meets the eye—a case report and review of literature

“…Most isolated muscular and subcutaneous cysticercosis is symptomless and goes undiagnosed throughout the life of the patient. In a few rare instances, there can be a trauma to the cyst or the parasite inside it may die, releasing antigens that set off an immune reaction and inflammation, causing the cyst to become symptomatic [ 13 ]. Interestingly, Rangdal et al .…”

“…Interestingly, Rangdal et al . [ 13 ], in their study, reported a similar case where a 45-year-old man developed pain and swelling over his calf after a traumatic injury, which was later proven to be a case of an intramuscular cysticercosis.…”

A rare case of isolated cysticercosis of brachialis muscle

“…Only a few case reports of isolated muscular cysticercosis have been reported in the English literature. [8][9][10][11][12][13] Probably it is the first case report of isolated brachialis muscle involvement by cysticercosis. Muscular cysticercosis often goes unnoticed because it remains asymptomatic in most individuals.…”