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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 59-61

Curious Subcutaneous Swellings: A Case of Pediatric Myocysticercosis


1 Department of Dermatology, GCS Medical College and Hospital, Ahmedabad, Gujarat, India
2 Department of Dermatology, SMT NHL Medical College and S.V.P Hospital, Ahmedabad, Gujarat, India
3 Intern, BJ Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Date of Submission17-Apr-2020
Date of Decision07-May-2020
Date of Acceptance04-Jun-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Kalgi Baxi
Department of Dermatology, GCS Medical College and Hospital, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_62_20

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  Abstract 


Cysticercosis is a parasitic infection caused by the larval stage of the tape worm, Cysticercus cellulosae, chiefly affecting the subcutaneous tissue, central nervous system, orbit, and the skeletal muscles. It occurs in human due to ingestion of contaminated water or raw meat of pig. We hereby present a case of a 6-year-old female presenting with multiple subcutaneous swellings of 3 months' duration, associated with painful movement and associated with a history of on and off fever and malaise. Local part ultrasonography revealed multiple cystic lesions in the muscular plane, with peripheral streak of calcification indicative of scolex. Fine-needle aspiration cytology of the lesions showed revealed degenerated and viable polymorphs, macrophages, few lymphocytes, and foreign body giant cells with foci of necrosis, with occasional hooklets of parasite, with findings suggestive of parasitic infection in neck with acute on chronic inflammation. Computed tomography (CT) scan of brain was normal. Thus, clinical, radiological, and cytological findings confirmed the diagnosis of myocysticercosis. This case is presented because of the rareness of its occurrence.

Keywords: Cysticercus cellulosae, myocysticercosis, subcutaneous swellings


How to cite this article:
Baxi K, Rathod SP, Majmundar V. Curious Subcutaneous Swellings: A Case of Pediatric Myocysticercosis. Indian J Paediatr Dermatol 2021;22:59-61

How to cite this URL:
Baxi K, Rathod SP, Majmundar V. Curious Subcutaneous Swellings: A Case of Pediatric Myocysticercosis. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Jan 25];22:59-61. Available from: https://www.ijpd.in/text.asp?2021/22/1/59/305813




  Introduction Top


Cysticercosis is a parasitic infection caused by the larval stage of the tape worm, Cysticercus cellulosae, chiefly affecting the subcutaneous tissue, central nervous system, orbit, and the skeletal muscles. It occurs in human due to the ingestion of contaminated water or raw meat of pig (intermediate host). Cysticerci are spherical milky white cysts containing fluid and a single invaginated scolex with hooklets. The larvae penetrate the mucosa, enter the blood vessels and lymphatics, and are distributed in the tissues all over the body. Cysticerci in the muscles generally do not cause symptoms; they present as nodules, can be felt as lumps under the skin, and tend to appear and disappear, or they can present as muscular pseudohypertrophy.[1] We hereby present a case of muscle cysticercosis in a 6-year-old patient, presenting as multiple subcutaneous swellings.


  Case Report Top


A 6-year-old female presented to the dermatology outpatient department with chief complaints of painful, subcutaneous swellings over multiple parts of the body since 3 months. The swellings were associated with painful locomotion of the underlying part. There was an associated history of mild occasional fever and malaise.

On examination, multiple firm cystic, fixed, nontender swellings, each of nearly 5 cm length and breadth were present over the neck, right upper arm, left infrascapular area, and anterior part of the right thigh, with overlying skin with normal color, texture, temperature without any underlying tethering or puckering [Figure 1]. Rest of the cutaneous and systemic examination was within normal limits.
Figure 1: Multiple, skin colored, spherical subcutaneous swellings over the anterior cervical region (a), infrascapular area (b), upper arm (c). Ill-defined bulge appreciable over the thigh, more palpable than visible

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Local part ultrasonography [Figure 2] revealed all lesions in the muscular plane, showing well defined cystic area with peripheral calcified streak (scolex) with peripheral edema, the radiological diagnosis being suggestive of parasitic infection, with possibility of myocysticercosis.
Figure 2: Local part ultrasonography showing lesions in the muscular plane, showing well defined cystic area with peripheral calcified streak (scolex) and peripheral edema

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Fine-needle aspiration cytology was done from the upper back and cervical swelling. The aspirate yielded blood mixed with purulent material. Microscopic examination of the aspirate revealed degenerated and viable polymorphs, macrophages, few lymphocytes, and foreign body giant cells with foci of necrosis, with occasional hooklets of parasite, with findings suggestive of parasitic infection in neck with acute on chronic inflammation. CT scan of the brain was performed, but did not show any lesions. Thus, from the clinical, radiological, and cytological findings, the diagnosis of myocysticercosis was confirmed.


  Discussion Top


Cysticercosis usually occurs as a result of consumption of food or water contaminated by human feces containing Taenia solium eggs. In the life cycle of T. Solium, humans are the only definitive host. Ingestion of undercooked pork containing these cysticerci is the exclusive path to the development of human intestinal T. solium tapeworms. There is also a high risk of infection by reverse peristalsis resulting in internal regurgitation of the eggs into the stomach when the intestine harbors a gravid worm. The oncospheres penetrate the intestinal mucosa and develop into cysticerci after getting carried to various parts of the body including brain, eyes (which constitute nearly 68%), striated muscles, liver, heart, lungs, peritoneum, breast, and subcutaneous tissues. The symptomatology and clinical features can be attributed to granulomatous inflammation in response to the cysticerci.[2]

Subcutaneous cysticercosis presents to a dermatologist with multiple palpable cystic lesions. Cysticercosis in the muscle may present three types of manifestation such as myalgia, pseudotumor, and abscess or rarely the pseudohypertrophic type. In the myalgia subtype, the patient complains of severe muscle pain due to acute inflammation caused by dead larva and leakage of cyst fluid. In pseudotumor or abscess subtype, a circumscribed mass develops due to chronic inflammation with a collection of fluid around the cyst, following intermittent leakage of cyst fluid. The third and rare pseudohypertrophic type develops due to calcification of scolex, thickening of capsule wall, and retraction of the cyst.[3]

The abscess type, as in this case, may be the most likely to present to dermatologists. It is most easily confused with lipoma, dermoid cyst, subcutaneous neurofibromas, lymphadenitis, fat necrosis, and pyomyositis.

In our case, clinical, cytological, and radiological correlation helped in clinching the diagnosis.

The patient was treated[4] with full dose of albendazole (15 mg/kg/day) and praziquantel (50 mg/kg/day) for 2 weeks, which led to resolution of symptoms. The cysts were persistent and showed slow decrease in size, last documented for up to 18 weeks after the completion of treatment.

Our patient did not have any neurological or ophthalmological abnormalities, as confirmed by CT scan and a detailed ophthalmological examination.


  Conclusion Top


Myocysticercosis is a rare but important differential diagnosis to be considered in patients presenting with subcutaneous swelling. Isolated myocysticercosis in pediatric age group is also an uncommon occurrence.

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh S, Singh AK, Sharma NK, Pandey A. Solitary myocysticercosis of masseter muscle: A rare presentation. Natl J Maxillofac Surg 2018;9:229-31.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Gupta S, Gupta S, Mittal A, Mahendra A, Aggarwal A, Batra R, Jindal N. A rare manifestation of cysticercosis infestation. Acta Med Indones 2014;46:54-7.  Back to cited text no. 2
    
3.
Mittal A, Das D, Iyer N, Nagaraj J, Gupta M. Masseter cysticercosis – A rare case diagnosed on ultrasound. Dentomaxillofac Radiol 2008;37:113-6.  Back to cited text no. 3
    
4.
Sidhu R, Nada R, Palta A, Mohan H, Suri S. Maxillofacial cysticercosis: Uncommon appearance of a common disease. J Ultrasound Med 2002;21:199-202.  Back to cited text no. 4
    


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