Low Back Pain and Foot Drop Associated with Dog Tapeworm Infection

Ayush Agarwal Department of Neurology, AIIMS, New Delhi, India;

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Venugopalan Y. Vishnu Department of Neurology, AIIMS, New Delhi, India;

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Ajay Garg Department of Neuroradiology, AIIMS, New Delhi, India

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A 61-year-old woman presented with low back pain associated with radiation to left lower limb since the past 1 year, with left foot drop since the past 1 month. Examination revealed wasting of the left lower limb with a foot drop. The remaining neurological examination was normal. Magnetic resonance imaging of the spine revealed diffusely bulky and multi-septated homogenous fluid-filled lesions (with signal intensity similar to cerebrospinal fluid [CSF]) in the intraspinal compartment from L3 to sacral vertebrae, causing extradural compression, and prevertebral and paravertebral locations (Figure 1). Contrast-enhanced computed tomography of the abdomen revealed similar cysts in the retroperitoneum, liver, and left psoas muscle. Serum ELISA was positive for Echinococcus IgG antibody (value-19.31; normal < 9), thus confirming the diagnosis of disseminated hydatidosis.

Figure 1.
Figure 1.

Sagittal T1-WI (A), sagittal (B and C) and coronal T2-WIs (D) show multiple well-defined cystic lesion in the intraspinal, preverebral, and presacral spaces (arrows in B and C) and in neural foramina (arrowsheads in C). Like the CSF, the lesions are hypointense on T1-WI (A) and hyperintense on T2-WI (B and C). Axial T2-WIs at L5 (E) and S1 levels (F) show intraspinal lesions (arrowheads in E) and lesions invoking the left psoas muscle (arrows in E and F).

Citation: The American Journal of Tropical Medicine and Hygiene 104, 1; 10.4269/ajtmh.20-1011

Hydatid disease is a parasitic infection caused by the larval form of Echinococcus granulosus. 1 Humans are intermediate hosts who become infected by accidental consumption of infected food/water, 2 with liver and lungs being the commonest sites of involvement. 3 Bone involvement is rare, occurring in less than 2% cases, with spinal involvement occurring in half of those cases. 3 The thoracolumbar spine is the common site of involvement, with involvement of the sacral spine being very rare. 4 ELISA serology has a sensitivity of 80–100% for hepatic infections but only 25–56% for other organ involvement. 5

In patients hailing from endemic regions and presenting with chronic low backache, with imaging suggestive of space-occupying lesions, hydatid disease should be considered in differential diagnosis. Early diagnosis and treatment lead to good clinical outcomes.

REFERENCES

  • 1.

    Papanikolaou A , 2008. Osseous hydatid disease. Trans R Soc Trop Med Hyg 102: 233238.

  • 2.

    Khiari A , Fabre JM , Mzali R , Domergue J , Beyrouti MI , 1995. Unusual locations of hydatid cysts. Ann Gastroenterol Hepatol (Paris) 31: 295305.

    • Search Google Scholar
    • Export Citation
  • 3.

    Agarwal S , Shah A , Kadhi SK , Rooney RJ , 1992. Hydatid bone disease of the pelvis. A report of two cases and review of the literature. Clin Orthop Relat Res 280: 251255.

    • Search Google Scholar
    • Export Citation
  • 4.

    Segura-Trepicho M , Montoza-Nunez JM , Candela-Zaplana D , Herrero-Santacruz J , Pla-Mingorance F , 2016. Primary sacral hydatid cyst mimicking a neurogenic tumor in chronic low back pain: case report and review of literature. J Neurosci Rural Pract 7: S112S116.

    • Search Google Scholar
    • Export Citation
  • 5.

    Karadereler S , Orakdögen M , Kiliç K , Ozdogan C , 2002. Primary spinal extradural hydatid cyst in a child: case report and review of the literature. Eur Spine J 11: 500503.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Venugopalan Y. Vishnu, Department of Neurology, Cardioneurosciences Centre, AIIMS, Room no. 704, New Delhi-110029. E-mail: vishnuvy16@yahoo.com

Authors’ addresses: Ayush Agarwal and Venugopalan Y. Vishnu, Department of Neurology, AIIMS, New Delhi, India, E-mails: ayushthetaurian@gmail.com and vishnuvy16@yahoo.com. Ajay Garg, Department of Neuroradiology, AIIMS, New Delhi, India, E-mail: drajaygarg@gmail.com.

  • Figure 1.

    Sagittal T1-WI (A), sagittal (B and C) and coronal T2-WIs (D) show multiple well-defined cystic lesion in the intraspinal, preverebral, and presacral spaces (arrows in B and C) and in neural foramina (arrowsheads in C). Like the CSF, the lesions are hypointense on T1-WI (A) and hyperintense on T2-WI (B and C). Axial T2-WIs at L5 (E) and S1 levels (F) show intraspinal lesions (arrowheads in E) and lesions invoking the left psoas muscle (arrows in E and F).

  • 1.

    Papanikolaou A , 2008. Osseous hydatid disease. Trans R Soc Trop Med Hyg 102: 233238.

  • 2.

    Khiari A , Fabre JM , Mzali R , Domergue J , Beyrouti MI , 1995. Unusual locations of hydatid cysts. Ann Gastroenterol Hepatol (Paris) 31: 295305.

    • Search Google Scholar
    • Export Citation
  • 3.

    Agarwal S , Shah A , Kadhi SK , Rooney RJ , 1992. Hydatid bone disease of the pelvis. A report of two cases and review of the literature. Clin Orthop Relat Res 280: 251255.

    • Search Google Scholar
    • Export Citation
  • 4.

    Segura-Trepicho M , Montoza-Nunez JM , Candela-Zaplana D , Herrero-Santacruz J , Pla-Mingorance F , 2016. Primary sacral hydatid cyst mimicking a neurogenic tumor in chronic low back pain: case report and review of literature. J Neurosci Rural Pract 7: S112S116.

    • Search Google Scholar
    • Export Citation
  • 5.

    Karadereler S , Orakdögen M , Kiliç K , Ozdogan C , 2002. Primary spinal extradural hydatid cyst in a child: case report and review of the literature. Eur Spine J 11: 500503.

    • Search Google Scholar
    • Export Citation
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