Disseminated cysticercus involving the vocal cords

Cysticercosis is a larval form of human infection by taenia solium. It develops in subcutaneous tissues, muscles, visceras, and most importantly as brain and eye infections. In developing countries, it is the leading cause of fits. The involvement of vocal cords is a rare finding.

Keywords: Cysticercosis, magnetic resonance imaging

Cysticercosis is one of the most important parasites and is a leading cause of multiorgan infections. Involvement of the central nervous system, subcutaneous tissues, and orbits are very common. We are presenting an infection of the vocal cords by cysticercus, which is a rare finding. Confirmatory diagnosis is usually done by histological examination from subcutaneous nodules.

Our case is one of a 27-year-old male patient who was suffering from multiple subcutaneous nodules mainly over the forehead and neck and also had intramuscular nodules. He had hypertrophy of the deltoid and calf muscles. He had an episode of fits 3 years back and a computed tomography (CT) scan showed multiple, calcified, nodular and ring enhancing lesions scattered in the cerebral parenchyma suggestive of neurocysticerci [Figure 1]. A histopathological examination of subcutaneous nodules had revealed a small cyst containing a degenerated parasite suggestive of cysticercus. He also had difficulty with his vision in the right eye and a CT scan revealed a cyst involving the right orbit [Figure 2]. Recently, the patient had developed hoarseness of voice.

On clinical examination, the vocal cords were swollen bilaterally. Magnetic resonance imaging (MRI) revealed cystic lesions involving both the vocal cords with similar lesions also involving subcutaneous planes histopathologically which had been suggested as cysticercus [Figure 3] and [Figure 4]. The patient was given treatment with mark improvement in his voice and resolution of the lesion.

Cysticercosis is the infestation by cysticercus cellulosae, the larval form of the pork tapeworm taenia solium. It is contracted by the ingestion of uncooked pork, vegetables, or water contaminated with the eggs of taenia solium. Sites of involvement are the central nervous system, subcutaneous tissues, skeletal muscles, heart muscles, and eyes. ^[1],[7] An unusual location in soft tissue is a rare finding. ^[2],[3],[4]

In nervous system infections, the larvae undergoes a series of changes from the first stage, which is a larval infection and not usually imagined. MRI manifestations of neurocysticerosis vary with the stages of the disease. There are 4 stages: live innocuous cyst, early degenerating stage, cysticercus granuloma, and healing lesions. ^[6] The final stage is the calcified stage, which describes complete involution of the lesion with continued mineralization. Presentation in soft tissues can be cystic, degenerative, or as a calcified nodule.

Due to the diverse clinical spectrum, neurocysticercus poses a complex diagnostic and treatment dilemma. The management of extraocular muscle cysticercosis ^[5] has undergone a radical change, with successful results of a medical alternative to surgical excision of the cysts in the form of albendazole and praziquantel along with oral corticosteroids, ^[6] which have been found to be very effective. Our patient also did well with medical treatment.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.50688

[Figure 1], [Figure 2], [Figure 3], [Figure 4]