Isolated Echinococcus granulosus hydatid cyst in the CNS with severe reaction to treatment
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We report a case of singular cerebral Echinococcus granulosus with a severe meningeal inflammatory reaction to anthelmintic therapy. A 42-year-old man had had recurrent headaches for 7 years. During each episode he had a deep boring pain arising in the left temporal region, spreading to the whole head and lasting up to weeks. He tried several analgesics to no avail and was admitted to the hospital. On examination, there were no neurologic abnormalities. Cranial CT showed two cystic hypodense lesions in the left frontotemporal area, which were probably communicating (figure, A and B). Laboratory testing revealed an increase in serum glutamic-pyruvic transaminase and gamma-glutamyl transpepdidase (γ-GT) but no eosinophilia and a normal serum immunoglobulin (Ig) E level. A lumbar puncture showed a pleocytosis of 17 cells/μL, an increased protein content of 80 mg/dL, and weak oligoclonal bands. A serologic test result was positive for anti–E. granulosus antibodies in serum and CSF (EgH antigen ELISA-positive in serum and CSF, arc-5-precipitation electrosyneresis and 8 kDa-band positive in serum and negative in CSF). …
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