Abstract:

In October 2021, a 55-year-old female patient from Bengbu, Anhui, was admitted to Huashan Hospital Affiliated to Fudan University with the main complaint of “intermittent low fever, dry cough with hydrocephalus for more than 1 year”. In the previous year, the patient repeatedly developed fever with a body temperature of 37.5-38.0 ℃ and paroxyresis of dry cough. Head CT examination revealed hydrocephalus, and laparoscopic-assisted ventriculoperitoneal shunt was performed in the hospital on September 28. The fever and cough remained after the operation, and enhanced head MRI showed “abnormal enhancement shadows in the sellar region and basal cistern”. A total number of 208 721 copies of Taenia solium sequence was detected in the cerebrospinal fluid based on metagenomic next-generation sequencing (mNGS), and the serum cysticercosis antibody was positive. In the epidemiological history, the patient denied eating raw pork, but had eaten incompletely cleaned raw vegetables for many times in the past 2 years. Combining imaging findings, laboratory tests and mNGS results, the patient was diagnosed with “cerebral cysticercosis”. The patient then started to take albendazole for two courses, the total amount of each course was 150 mg/kg, the first course lasted for 12 days, and the second course lasted for 8 days, and the patient had no noticeable discomfort during the treatment. After the first course of treatment, enhanced head MRI showed abnormal enhancement shadow in the saddle region and basal cistern, and the enhancement degree was less than that of the previous film. The re-examination of the head CT showed hydrocephalus, changes after the lateral ventricular drainage, the extent of ventricular enlargement had slightly reduced, and the density of the saddle area was not uniform. Regular follow-up was undertaken at the end of the course of treatment by other hospitals.

Key words: Cerebral cysticercosis, Taenia solium, Metagenomics next-generation sequencing