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Published on: February 22, 2019
Metastatic malignancy masquerading as neurocysticercosis
Daniela E DiMarco1, Andrew J Hale1, Adam Ulano1
1University of Vermont Medical Center, Infectious Disease Unit, 111 Colchester Avenue, Mailstop 115 SM2, Burlington, VT 05401, United States.
Abstract:
Cystic brain lesions are a common clinical dilemma facing infectious disease providers. A broad differential diagnosis is required in the proper evaluation and care of patients facing such an illness. Here the authors describe the case of a 29-year-old woman who presented with seizures and was found to have multiple cystic brain lesions, with risk factors for neurocysticercosis. Ultimately, she was found to have a metastatic neuroendocrine malignancy. The authors review the ideal imaging and testing modalities in the diagnosis and exclusion of neurocysticercosis. This case serves as guidance for clinicians caring for patients with cystic brain lesions that may be infectious or non-infectious in etiology.
Insights
Cystic brain lesions can mimic neurocysticercosis but may represent malignancy. This case highlights the importance of a broad differential diagnosis for brain lesions, including non-infectious causes like metastatic neuroendocrine tumors.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Cystic brain lesions present a diagnostic challenge, necessitating a comprehensive differential diagnosis for accurate patient management.
- Infectious etiologies, such as neurocysticercosis, are often considered, but non-infectious causes must also be evaluated.
Observation:
- A 29-year-old woman presented with seizures and multiple cystic brain lesions.
- Initial considerations included neurocysticercosis due to identified risk factors.
- The patient was ultimately diagnosed with a metastatic neuroendocrine malignancy.
Findings:
- The case underscores the critical need to differentiate between infectious and non-infectious cystic brain lesions.
- Diagnostic modalities for neurocysticercosis, including imaging and specific testing, are reviewed.
- Metastatic neuroendocrine malignancy was the underlying cause, not neurocysticercosis.
Implications:
- Clinicians should maintain a high index of suspicion for non-infectious etiologies, such as malignancy, in patients with cystic brain lesions.
- A thorough diagnostic workup is essential to avoid misdiagnosis and ensure appropriate treatment for diverse etiologies.
- This case provides valuable guidance for the evaluation of complex cystic brain lesions in clinical practice.
