Disseminated intramuscular cysticercosis diagnosed incidentally in a patient with joint pain

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345
Radiol Bras. 2019 Set/Out;52(5):342–348
Letters to the Editor
http://dx.doi.org/10.1590/0100-3984.2017.0177
Mustafa Resorlu1,a, Ozan Karatag1,b, Fatma Uysal1, Ozge Caglar1,c
1. Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey.
Correspondence: Mustafa Resorlu, MD. Canakkale Onsekiz Mart University, Terzioğlu
Yerleşkesi, Barbaros Mh, 17100, Canakkale, Turkey. Email: mustafaresorlu77@
gmail.com.
a. https://orcid.org/0000-0002-2941-8879; b. https://orcid.org/0000-0002-0606-6364;
c. https://orcid.org/0000-0001-8737-2891.
Received 2 October 2017. Accepted after revision 20 December 2017.
Surgical treatment, if required, involves radical excision and re-
construction(3,5).
REFERENCES
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sia. Head Face Med. 2009;5:22.
2. Karligkiotis A, Terranova P, Dallan I, et al. Monostotic brous dysplasia of
the inferior turbinate. Otolaryngol Head Neck Surg. 2012;146:1035–6.
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Oral Pathol Oral Radiol. 2013;116:680–5.
Three different CT imaging patterns have been reported
in FD(2,4): ground-glass (the most common and characteristic);
sclerotic; and lytic. MRI is used for diagnostic purposes or to
show relationships with the adjacent anatomical structures. On
T1- and T2-weighted images, the lesion is sharply marginated
and hypointense. However, the diagnostic efcacy of MRI de-
creases when the signal is hyperintense on T2-weighted images
in particular(3).
Lysis developing in the area of an FD lesion, calcied foci,
a periosteal reaction contiguous to the lesion, a cortical defect,
and a soft-tissue mass observed at radiology indicate malignant
transformation. In monostotic FD, malignant transformation is
more common in individuals with craniofacial involvement than
in those with involvement of other bones. The most common
malignant transformation of FD is to osteosarcoma(4). In the
case presented here, homogeneous ground-glass opacity, which
is typical of FD, was seen on CT. The preliminary diagnosis of
FD, based on the radiological ndings, was conrmed by histo-
pathology.
In patients with FD, small, asymptomatic lesions not caus-
ing any cosmetic deformity can be monitored. Patients in pain
can be treated with bisphosphonates, vitamin B, or calcitonin(3).
Disseminated intramuscular cysticercosis diagnosed incidentally
in a patient with joint pain
Dear Editor,
A 43-year-old male resident of a rural area presented with
a two-month history of pain in his right leg, predominantly in
the hip region, the pain having progressively increased in inten-
sity. Physical examination showed mild pain during active and
passive movement of the limb. Laboratory tests showed no sig-
nicant changes, except for a slightly elevated erythrocyte sedi-
mentation rate. A plain X-ray demonstrated multiple radiopaque
rhizoid images, distributed throughout various muscle planes
(Figures 1A and 1B). Computed tomography revealed numer-
ous calcications in the muscle groups of both legs (Figures 1C
and 1D). The diagnostic hypothesis was muscular cysticercosis.
Pathological analysis of a muscle tissue sample conrmed that
diagnosis. The patient was started on a 30-day course of alben-
dazole and prednisone, which resulted in improvement of all of
the signs and symptoms.
Diseases caused by uncommon infectious agents have re-
cently been described in the radiology literature of Brazil(1–4).
Taeniasis and cysticercosis are two distinct entities. Although
cestodes of the same genus are responsible for both diseases,
the stage of the cestode at infection differs between the two.
Taeniasis is caused by the adult forms of Taenia solium or Taenia
saginata infesting the small intestine of its denitive host, hu-
man beings. However, cysticercosis is caused by the larval form
of tapeworms infesting the tissues of its intermediate hosts (pigs
and cows). In human cysticercosis, humans are categorized
as accidental intermediate hosts(5). The eggs enter the human
intestine by fecal–oral contamination, by autoinfection, or by
ingestion of contaminated food or water(6). Eggs develop into
Figure 2. CT of the paranasal sinus showing
a ground-glass opacity causing expansion of
the right inferior turbinate (arrow).
Figure 1. Axial T1- and T2-weighted MRI sequences (A and B, respectively), showing a hypointense lesion (arrow)
consistent with FD.
A B

346 Radiol Bras. 2019 Set/Out;52(5):342–348
Letters to the Editor
http://dx.doi.org/10.1590/0100-3984.2017.0219
Denise Maria Rissato Camilo1,a, Tiago Kojun Tibana1,b, Rômulo
Florêncio Tristão Santos1,c, Edson Marchiori2,d, Thiago Franchi Nunes1,e
1. Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Bra-
zil. 2. Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Correspondence: Dr. Thiago Franchi Nunes. Avenida Senador Filinto Müller, 355,
Vila Ipiranga. Campo Grande, MS, Brazil, 79080-190. Email: thiagofranchinunes@
gmail.com.
a. https://orcid.org/0000-0002-9016-8610; b. https://orcid.org/0000-0001-5930-1383;
c. https://orcid.org/0000-0002-8679-7369; d. https://orcid.org/0000-0001-8797-7380;
e. https://orcid.org/0000-0003-0006-3725.
Received 13 November 2017. Accepted after revision 22 December 2017.
larvae that spread throughout the intestinal wall and are dis-
seminated through the bloodstream to the brain, muscles, sub-
cutaneous tissues, or other organs(5).
Cysticercosis is endemic in many parts of the world, par-
ticularly in Latin America, Africa, and Asia. However, a trend
toward gradual growth is observed in developed countries, due
to the increase in travel and immigration(7,8). The preferred
sites of infestation are the central nervous system, in 70–80%
of cases; the eye, in 18–20% of cases; the skin, in 10–12% of
cases; and the musculature, in 5–6% of cases. Infestation of
the musculature does not result in specic clinical symptoms or
signs. In most cases, the symptoms are mild. Muscle pains and
weakness can occur, as can lower limb paresthesia and hydrar-
throsis of the knee. Signicantly altered muscle function, with
evident changes on physical examination, is rare. The muscular
form of cysticercosis has been identied as an incidental nding
on radiological examinations that focus on the soft tissues and
demonstrate the characteristic calcications(9).
The treatment of intramuscular cysticercosis depends on
the presence of symptoms, especially on whether there is pain
or a local inammatory process. Treatment modalities include
the use of anthelmintics such as albendazole and praziquantel
(in patients with viable cysts), the use of corticosteroids or other
agents to suppress or prevent the immune response of the host,
and surgical intervention in selected cases(10,11).
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tally diagnosed in a patient of fracture shaft of femur. BMJ Case Rep.
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intramedular: relato de caso e revisão da literatura. Radiol Bras. 2003;
36:255–7.
7. Sharma BS, Banerjee AK, Kak VK. Intramedullary spinal cysticer-
cosis. Case report and review of literature. Clin Neurol Neurosurg.
1987;89:111–6.
8. Liu H, Juan YH, Wang W, et al. Intramuscular cysticercosis: starry sky
appearance. QJM. 2014;107:459–61.
9. Armbrust-Figueiredo J, Speciali JG, Lison MP. Forma miopática da cisti-
cercose. Arq Neuro-Psiquiatr (São Paulo). 1970;28:385–90.
10. Nash TE. Human case management and treatment of cysticercosis. Acta
Trop. 2003;87:61–9.
11. Tripathy SK, Sen RK, Akkina N, et al. Role of ultrasonography and mag-
netic resonance imaging in the diagnosis of intramuscular cysticercosis.
Skeletal Radiol. 2012;41:1061–6.
Figure 1. Plain X-rays (A,B) showing ra-
diopaque rhizoid images in the muscle
planes. Coronal and axial computed to-
mography scans (C and D, respectively)
showing diffuse intramuscular calcica-
tions.
A B
CD