Abstract:

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