收稿日期: 2022-04-26
修回日期: 2022-07-12
网络出版日期: 2022-12-16
A misdiagnosed case of brain sparganosis mansoni
Received date: 2022-04-26
Revised date: 2022-07-12
Online published: 2022-12-16
患者，男，16岁，在读学生，成都市新都区人。于2017年因癫痫发作，在外院就诊，误诊为“脑血管瘤”，先后行伽马刀术3次，术后症状均有所改善；于2021年11月因视物重影、言语失流利、步态不稳等症状，且影像学检查示不排除患“脑肿瘤”可能，再次行脑部开颅手术，术中见脑组织内有白色棉线样虫体1条，考虑可能是“寄生虫”，遂将患者转院至成都市公共卫生临床医疗中心作进一步的诊治。入院后询问患者病史并进行相关检查。患者曾有食未煮熟水产品史。血常规检查示，嗜酸粒细胞数和百分比均在正常范围；血清学检测结果为裂头蚴IgG抗体阳性。复阅上家医院拍摄的影像学报告和病理切片等，MRI报告示，脑干区、左侧小脑半球不均匀片状异常信号，增强后呈环状强化；CT报告示，脑干左侧份（桥脑及中脑）、左侧小脑半球斑点状及小结节强化；脑组织病理切片，见典型坏死性隧道及肉芽肿，并可见寄生虫样虫体结构3段，虫体有体壁横纹、体内纵行肌及石灰小体等为“曼氏裂头蚴”虫体特征性结构。确诊该患者为脑裂头蚴病。予吡喹酮治疗[25 mg/(kg·d)× 4 d（共4个疗程，每次间隔1个月）]，首个疗程后出院。6个月后随访，影像学复查示脑部病灶基本消失，临床症状明显好转。
荣智利 , 石婷婷 . 脑曼氏裂头蚴病误诊1例[J]. 中国寄生虫学与寄生虫病杂志, 2022 , 40(6) : 817 -820 . DOI: 10.12140/j.issn.1000-7423.2022.06.022
A 16-year-old male patient, who is a student, lived in Xindu district of Chengdu. In 2017, the patient was misdiagnosed as having "cerebral hemangioma" due to epilepsy in another hospital, followed by gamma knife radiosurgery three times. The patien’s symptoms were relieved after each operation. However, the patient underwent brain surgery due to visual ghosting, unable to speak freely, gait instability and radiographic suggests brain tumour could not be excluded in July 2021. During the surgery, one white worm was found in the brain tissue. The patient was transferred to the Public health clinical centre of Chengdu due to a suspected parasitic infection. The patient had a history of consuming uncooked aquatic products, blood cell count showed eosinophil count and eosinophil percentage were normal, and serum Sparganum mansoni specific IgG antibodies were positive. MRI showed inhomogeneous flaky abnormal signal and ring strengthening after enhancements in the brainstem and left cerebellar hemisphere, and CT showed speckle and small nodule enhancement in left brainstem(pons and midbrain) and left cerebellar hemisphere. Brain histopathology showed necrotic tunnel and granulomatous inflammation. The transverse striation of the body wall, longitudinal muscle and calcareous corpuscles were found in the three parasite bodies. Therefore, the patient was diagnosed with cerebral sparganosis. Praziquantel [25 mg/(kg·d), lasted 5 days, 4 courses, each treatment interval of 1 month] was used for deworming treatment. The radiographic changes mostly disappeared and the symptoms improved after 6 months.
Key words： Epilepsy; Parasite; Sparganum mansoni; Cerebral sparganosis
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