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|Year : 2019 | Volume
| Issue : 6 | Page : 1571-1572
Department of Neurology, Nagpal Neuro and Arthritis Center, Bhanwartal, Jabalpur, Madhya Pradesh, India
|Date of Web Publication||20-Dec-2019|
Dr. Tarun Nagpal
Nagpal Neuro and Arthritis Center, Bhanwartal, Jabalpur, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nagpal T. Lingual Cysticercosis. Neurol India 2019;67:1571-2
Neurocysticercosis is a common parasitic disease of the nervous system. However, tongue cysticercosis is rare and only 64 cases have been reported in the literature. We report a 14-year-old girl presenting with multiple soft swellings in the tongue. She also had cognitive decline.
A 14-year-old girl presented with multiple painless swellings in the tongue. Her relatives noted that she had gradually become bradyphrenic. Her school grades dropped owing to psychomotor retardation. The patient had an MMSE score of 22/30. She had brisk jerks with downgoing plantar reflexes.
Her tongue showed multiple cystic nodular swellings [Figure 1] and [Figure 2]. The largest of the swelling was around 3 cm × 2 cm and a non-tender, soft nodule with ill-defined margins on palpation. Her MRI of the brain showed multiple granulomas [Figure 3] and [Figure 4], which were suggestive of neurocysticercosis in different stages. A few granulomas also showed an eccentric scolex within [Figure 5].
|Figure 5: MRI Brain FLAIR coronal (right temporal lobe zoom) showing scolex inside one of the cyst|
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Excision biopsy of a tongue lesion was done and histopathology showed duct-like invagination of the larva of cysticercosis [Figure 6].
|Figure 6: Histopathology from excision biopsy showing duct-like invagination composing the larva lined by homogenous membrane (H & E stain)|
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Dixon and Lipscomb found that only 1.8% of the cases of cysticercosis had oral involvement.
The presentation as subcutaneous nodule on trunk, upper arm, eyes, neck, tongue, face, and breast has been reported in this order of frequency. Intraorally, the favored sites for the development of cysticerci are the lips, cheeks, and tongue. When presenting as an isolated lingual swelling, it may become a challenging diagnosis in view of the rarity of cysticercosis in the tongue. Characteristic histopathology of larva in the tissue helps diagnosis. In our case, however, the MRI brain scan (done in view of psychomotor cognitive decline) was suggestive of multiple neurocysticercosis making us suspect lingual cysticercosis even before it was confirmed by excision biopsy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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HBF Dixon, FM Lipscomb. Cysticercosis, an analysis and follow up of 450 cases: Privy Council, Med. Res. Council, Special Report series No. 299. Her Majesty's Stationery Office. London; 1961.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]