CASE REPORT: A SUSPECTED NEURCYSTICERCOSIS CASE WITH MULTI-STAGE CYSTICERCUS IN A MALE FROM PAPUA, INDONESIA

LAPORAN KASUS: SUATU KASUS TERDUGA NEUROSISTISERKOSIS DENGAN GAMBARAN SISTISERKUS MULTISTADIUM PADA SEORANG LAKI-LAKI DARI PAPUA, INDONESIA

Abstract

Introduction: Neurocysticercosis is a parasitic infection of the central nervous system due to the Taenia solium. Although it is rarely found in Manado, the case of migrants from endemic areas must always be considered. Management of neurocysticercosis must be done with caution, especially with anthelmintic administration, because it can cause clinical deterioration. Case Report: Male, 22 years old, originally from Papua, came with chief complaint of focal seizures that first occurred a year ago and was last occurred one month ago. The patient has a history of eating undercooked pork. Physical examinations were within normal limits. On neurobehavior examination, frontal lobe disorders were found. CT scan of the head showed a suggestive image of multi-stadium neurocysticercosis. A probable diagnosis of neurocysticercosis was then made. Patient was given albendazole 200 mg per 12 hours and phenytoin 100 mg per 12 hours. During one month of treatment there were no fever, seizure nor headaches. However, during control of neurobehavior examination, frontal lobe disorders were still found. Discussion: Seizures and executive function impairment are the clinical manifestations of neurocysticercosis found in this patient. Imaging results indicate lesions that are suggestive of neurocysticercosis but a definitive diagnosis cannot be made. Administration of anthelmintic is still controversial, including in this case, due to a multi-stadium stage. However, anthelmintic administration in this patient did not show any worsening until one month after therapy. Conclusion: In patients who have neurological imaging and appropriate clinical features accompanied by risk factors, the diagnosis of neurocysticercosis needs to be considered first because of the limited diagnostic facilities. In multi-stadium neurocysticercosis, anthelmintic therapy can be administered by taking into account the risk of clinical deterioration.

Keywords: Neurocysticercosis.

Abstrak

Pendahuluan: Neurosistiserkosis merupakan infeksi parasitik susunan saraf pusat akibat parasit Taenia solium. Meskipun sudah jarang ditemukan di Manado tetapi kasusnya pada pendatang dari daerah endemik harus selalu dipertimbangkan. Penatalaksanaan neurosistiserkosis harus dilakukan secara berhati-hati, terutama pemberian antelmentik, karena dapat menyebabkan perburukan klinis. Laporan Kasus: Seorang laki-laki, berusia 22 tahun, berasal dari Papua, datang ke klinik kami dengan keluhan kejang fokal yang terjadi sejak satu tahun yang lalu dan terakhir dirasakan satu bulan lalu. Pasien memiliki riwayat kebiasaan memakan daging babi yang kurang matang. Pemeriksaan fisik dalam batas normal. Pada pemeriksaan neurobehavior didapatkan gangguan lobus frontalis. Pemeriksaan CT scan kepala memperlihatkan gambaran yang sugestif neurosistiserkosis multistadium. Dibuat diagnosis probabel neurosistiserkosis. Pasien diberikan albendazol 200mg per 12 jam dan fenitoin 100mg per 12 jam. Selama satu bulan pengobatan tidak ditemukan demam, kejang, dan nyeri kepala. Namun demikian pemeriksaan neurobehaviour kontrol tetap menunjukkan gangguan lobus frontalis. Diskusi: Bangkitan dan gangguan fungsi luhur menjadi manifestasi klinis neurosistiserkosis pada pasien ini. Hasil pencitraan menunjukkan lesi yang sugestif neurosistiserkosis tetapi diagnosis definit tidak bisa ditegakkan. Pemberian antelmentik masih menjadi kontroversi, termasuk pada kasus ini, yang menunjukkan gambaran multistadium. Namun demikian, pemberian antelmentik pada pasien tidak memperlihatkan perburukan hingga satu bulan setelah terapi. Kesimpulan: Pada pasien yang memiliki pencitraan neurologis dan gambaran klinis yang sesuai disertai adanya faktor risiko, diagnosis neurosistiserkosis perlu dipikirkan terlebih dahulu karena keterbatasan fasilitas diagnostik. Pada neurosistiserkosis multistadium dapat diberikan terapi antelmentik dengan memperhatikan risiko perburukan klinis.

Kata kunci: Neurosistiserkosis.