A Patient of Neurocysticercosis Misdiagnosed as Tuberculous Meningitis for 26 Years: a Case Report

Background: Neurocysticercosis (NCC) is a neurological infection caused by the larval stage of the tapeworm Taenia solium (T. solium). The diagnosis of NCC can be challenging because of heterogeneity in clinical manifestation. Neurocysticercosis is easily misdiagnosed as tuberculous meningitis (TBM).Case presentation: We describe a case of subarachnoid neurocysticercosis with 28 years illness course misdiagnosed as TBM for 26 years. The patient presented with symptoms of repeated headache, fever, serious low back and legs pain, and vomiting, occasional seizure and lose of consciousness. The neurological assessments revealed stiff neck and right plantar and saddle numbness. Lumbar puncture results revealed obvious intracranial hypertension, pleocytosis, elevated protein level, and decreased glucose level. Magnetic resonance imaging showed meningeal enhancement of brain, cystlike structure in the lumbosacral sac and the clumping of the nerve roots of the cauda equina. Five recurrent episodes occurred in twenty-eight years. TBM was considered as a probable etiology and was treated for tuberculosis empirically with adjunctive corticosteroids for 26 years. In the first three hospitalizations, During this period, the patient was hospitalized three times. In 2016, The local hypertrophic pachymeningitis were considered as a probable etiology. She was treated with steroid pulse therapy. At her fifth relapse, in 2018, next-generation sequencing of cerebrospinal fluid (CSF) identified the patient was NCC, T. solium infection. Her symptoms and CSF examination were relieved after etiological treatment. Conclusions: Neurocysticercosis is easily misdiagnosed as TBM. Meanwhile, adjunctive corticosteroids therapy can alleviate the symptom of TBM and NCC. So we suggest that NCC should be considered in the differential diagnosis of TBM. NGS of CSF is a promising tool for the diagnosis of NCC.