Spinal and vertebral neurocysticercosis in an HIV-positive female patient

Abstract

Neurocysticercosis (NCC) is a relatively common disease in South Africa. It occurs in the rural areas surrounding Bloemfontein in the Free State province, as well as in neighbouring Lesotho. We report on a 46-year-old female admitted with vertebral and spinal NCC, who was newly diagnosed with human immunodeficiency virus (HIV), and had a CD4 count of 46 x 106 cells/l. She presented with severe pain, associated with spasms and weakness of the lower limbs. She had similar prior episodes and underwent spinal surgery to evacuate cysts. Magnetic resonance imaging revealed a spinal lesion at T12, causing vertebral collapse. During subsequent surgery, cysts were extracted from the subarachnoid space and spinal medulla. Yamshidi needle biopsy of the vertebral body was performed and sent with the cysts for histological examination. A diagnosis of spinal NCC was made on the basis of histological findings. The patient had a recurrence of a former disease, leading to the question of whether or not this recurrence was as a result of a weakened immunity, due to her HIV status. The patient was treated with albendazole, steroids, analgesics, and amitriptyline. Her condition improved after surgery, and she was subsequently admitted to a regular ward. To our knowledge, this is the first case in the Free State of spinal NCC that extended into the adjacent vertebral body. The occurrence of cysticercosis is escalating due to factors such as HIV/AIDS, and poor socio-economic conditions. Its widespread distribution poses a research challenge with regard to the true extent of the disease.