Case Presentation: While neurocysticercosis is a common cause of acquired epilepsy in developing countries, it is rarely considered for new onset seizures in the United States. The primary route of transmission is through ingestion of Taenia Solium eggs, typically found in undercooked pork containing larvae, which are then shed in feces. We present an unexpected case of neurocysticercosis in a vegetarian patient in the United States.
Discussion: A female in her 30s with a past medical history of hypothyroidism presented to the emergency department with an altered mental status. She had been having intermittent episodes of staring, confusion, and nonsensical speech for a week. Computed tomography (CT) of the head showed a lesion in the posterior left temporal lobe with surrounding vasogenic edema. Her hospital course was complicated by multiple seizures, requiring intubation for airway protection in status epilepticus. Magnetic resonance imaging of the brain revealed a left temporal rim-enhancing lesion concerning for neurocysticercosis. Further workup confirmed neurocysticercosis with a positive Taenia solium IgG. Notably, the patient was a vegetarian with no history of pork ingestion. She had moved to the United States from India one year prior. She was successfully treated with a 14-day course of albendazole, as well as with steroids for cerebral edema, and did not suffer from persistent neurological deficits.
Conclusions: While infrequently encountered in the United States, due to the rising incidence of neurocysticercosis in this country, this condition should be considered in patients presenting with epilepsy and lesions on brain imaging, particularly among immigrants or travelers returning from endemic regions. Common symptoms include seizures and headaches. While frequently acquired from ingestion of undercooked pork, this pathogen can also infect patients through contaminated produce and water, as well as through a tapeworm carrier. The incubation period can be prolonged, making detection of the source difficult. Although treatable with antiparasitic drugs such as albendazole, timely recognition is important due to life threatening complications such as status epilepticus, as was seen in this patient’s case.
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