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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 1  |  Page : 102-103

Sparganosis of the cauda equina: A rare case report and review of the literature


Department of Surgery, Division of Neurosurgery, Cathay General Hospital, Taipei, Taiwan, China

Date of Submission05-Oct-2011
Date of Decision02-Nov-2011
Date of Acceptance29-Dec-2011
Date of Web Publication7-Mar-2012

Correspondence Address:
Chih-Ta Huang
Department of Surgery, Division of Neurosurgery, Cathay General Hospital, Taipei, Taiwan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.93598

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How to cite this article:
Huang CT, Chang MY, Chang CJ, Hsieh CT, Huang JS. Sparganosis of the cauda equina: A rare case report and review of the literature. Neurol India 2012;60:102-3

How to cite this URL:
Huang CT, Chang MY, Chang CJ, Hsieh CT, Huang JS. Sparganosis of the cauda equina: A rare case report and review of the literature. Neurol India [serial online] 2012 [cited 2019 Aug 21];60:102-3. Available from: http://www.neurologyindia.com/text.asp?2012/60/1/102/93598


Sir,

Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larvae (sparganum) of the genus Spirometra and was first reported in humans by Cobbla. [1] Till date only 12 cases of spinal sparganosis have been reported. [2],[3],[4],[5] We report a case of sparganosis of the cauda equina.

A 26-year-old female presented with general skin rash and itching, followed by progressive low back pain, weakness of both lower extremities, and urinary incontinence of four months' duration. Neurologic examination revealed motor power Grade 3/5 in the left lower extremity and hypoesthesia, including loss of pinprick, temperature and light touch sensations. Laboratory tests revealed: white blood cell count of 5210/ cmm, with 2.3% eosinophil count. The C-reactive protein level was 0.267 mg/dl. Magnetic resonance images of the spine demonstrated an extensive intradural lesion with a heterogeneous signal from L4 to S2 levels [Figure 1]a and b. She underwent a laminectomy from L3 to S2. At operation, the arachnoid membrane was found to be thickened and yellowish-white in color due to severe inflammation and adhesion [Figure 2]. A soft ivory-colored mass was found adhering to the cauda equina. Pathological examination showed a reaction for dead parasite that had tegument and parenchymal smooth muscle in high-power view. The pathologist strongly confirmed that it was the larval form of Sparganum [Figure 3].
Figure 1: (a) Sagittal view of T1-weighted magnetic resonance image of spine with contrast enhancement revealed a heterogeneous mass located in the spinal canal from L4 to S2. Otherwise, the distension of the urinary bladder was also observed. (b) Axial view of T1-weighted magnetic resonance image revealed that the mass occupied the spinal canal without obvious interface between the mass and the cauda equina

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Figure 2: Operative picture showing the arachnoid membrane (black asterisk) thickened and yellowish-white due to severe inflammation and adhesion after opening the dura

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Figure 3: The microscopic view revealed the Spargarum with tegument (T) and parenchymal smooth muscle (M) (H and E, x200)

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Sparganosis is an uncommon infective disease in humans caused by pelocercoid larvae of the tapeworm genus Spirometra. It often reported in East and Southeast Asian countries. [2] In the lifecycle the intermediate hosts are freshwater fish, amphibians and reptiles. Humans are considered aberrant intermediate hosts, and the disease is caused by migration of larvae through tissues that may include the brain and spine. [6] The mechanism of the migration of the larvae to the central nervous system (CNS) is still unclear. The other entry into the CNS would likely be through "the hole" of a bony structure such as the foramen magnum. [4] Humans are infected by: (1) ingestion of the raw or undercooked flesh of snakes, frogs or freshwater fish infected with the Sparganum; (2) drinking untreated water containing infected copepods; and (3) using the raw flesh of an infected intermediate host in traditional poultices. [3] In our patient, the possible route was drinking untreated water, since she denied the other causes. Sparganosis usually presents with migratory subcutaneous nodules. [7] Acute angioedema or chronic skin rash may also play an important role in parasitic infection. [8] Sparganosis related to skin rash has not been reported prior to this case. The mechanism of the skin rash is unknown. Preoperative diagnosis of spinal sparganosis remains a challenge. It is difficult to differentiate this condition from other inflammatory or neoplastic disorders. [2],[3],[4] Diagnosis has usually been made after surgery based on the histological identification of the worm. The enzyme-linked immunosorbent assay (ELISA) measurement for the diagnosis of sparganosis is highly sensitive and specific. [2],[3] As it turned out, our preoperative impression was wrong, and we did not think about using the preoperative ELISA test. The optimal treatment of spinal sparganosis is the surgical removal of the worms and the granulation tissues. [3] In conclusion, although spinal sparganosis is a rare clinical condition, it should be included in the differential diagnosis of patients with a spinal lesion.

 
  References Top

1.TS. Cobbold Description of ligula mansoni, a new human cestode. J Lin Soc Lond 1883;17:78-83  Back to cited text no. 1
    
2.Kwon JH, Kim JS. Sparganosis presenting as a conus medullaris lesion: Case report and literature review of the spinal sparganosis. Arch Neurol 2004;61:1126-8.  Back to cited text no. 2
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3.Bao XY, Ding XH, Lu YC. Sparganosis presenting as radiculalgia at the conus medullaris. Clin Neurol Neurosurg 2008;110:843-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Oh SI, Koh SH, Pyo JY, Lee KY, Lee YJ. Sparganosis mimicking an intramedullary tumor of the cervical cord. J Clin Neurosci 2011;18:1128-9.  Back to cited text no. 4
[PUBMED]    
5.Park JH, Park YS, Kim JS, Roh SW. Sparganosis in the lumbar spine: Report of two cases and review of the literature. J Korean Neurosurg Soc 2011;49: 241-4.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Hughes AJ, Biggs BA. Parasitic worms of the central nervous system: An Australian perspective. Intern Med J 2002;32: 541-53.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Kim SH, Park K, Lee ES. Three cases of cutaneous sparganosis. Int J Dermatol 2001;40:656-8.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Varga M, Dumitrascu D, Piloff L, Chioreanu E. Skin manifestations in parasite infection. Roum Arch Microbiol Immunol 2001;60: 359-69.  Back to cited text no. 8
    


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