LETTER TO EDITOR
Year : 2000 | Volume
: 48 | Issue : 4 | Page : 331--2
An unusual presentation of orbital cysticercosis
S Vashisht, S Ahuja
|How to cite this article:|
Vashisht S, Ahuja S. An unusual presentation of orbital cysticercosis.Indian J Ophthalmol 2000;48:331-2
|How to cite this URL:|
Vashisht S, Ahuja S. An unusual presentation of orbital cysticercosis. Indian J Ophthalmol [serial online] 2000 [cited 2020 Apr 2 ];48:331-2
Available from: http://www.ijo.in/text.asp?2000/48/4/331/14832
Cysticercosis is the infestation by Cysticercusis cellulosae, the larval form of the pork tapeworm Taenia solium. It is contacted by ingestion of pork, vegetables, or water contaminated with the eggs of T.solium. Sites of predilection for the cysticerci to develop are CNS, subcutaneous tissue, skeletal muscle, heart muscle and eye. Ocular involvement occurs in 13-46% of infected patients. We recently encountered a patient infected by this entity in an unusual manner.
An 18-year-old girl presented with a gradually increasing swelling below left medial canthus for over a year. There was no history of pain, redness, lacrimation, nasal discharge or anosmia. No high-grade fever or a similar swelling elsewhere in the body was reported.
On clinical examination, a vertically oval swelling 9 mm x 5 mm was seen on the left anterior lacrimal crest, just below the medial canthus. The swelling was hard in consistency, fixed and non-tender. There was no regurgitation of fluid on pressing the swelling.
There was no associated sublingual, submandibular and preauricular lymphadenopathy. Syringing from the lower puncture was patent. Visual acuity was 6/6 in both eyes. The ocular and general physical examination was normal. The patient was a vegetarian.
A clinical pre-operative diagnosis of bone cyst was made. On ENT examination, anterior rhinoscopy was normal; endoscopy was not done. Routine blood examination was normal except for mild eosinophilia. ELISA for cysticercosis was negative. Plain X-ray of left orbit showed no bony erosion or abnormal clacification. The brain scan was found to be normal, while the orbital cuts showed a well circumscribed lesion with hyperdense margin and a central hyperdensity [Figure:1] and [Figure:2].
A provisional diagnosis of cysticercosis was considered. X-rays of thigh and upper arm did not reveal any abnormal calcification.
The cyst was excised under local anesthesia. The incision was made medial to the cyst. The tense cyst was found fixed to the subcutaneous tissue and was lying on the anterior lacrimal crest, attached by a peduncle to the medial palpebral ligament. It was not connected to the underlying muscle or bone. Histopathologic examination of the cyst confirmed the diagnosis wherein the parasite and the wall was seen as shown in the photomicrograph [Figure:3].
Cysticercus cyst can be lodged anywhere. A cyst on the anterior lacrimal crest has not been reported in the literature. The falacious diagnosis of a bone cyst was due to the tense cyst palpated against the anterior lacrimal crest and attached to the medial palpebral ligament by a peduncle. C.T.scan was the only diagnostic investigation which aided the diagnosis of cysticercosis. This emphasizes that cysticercosis should not be forgotten as a possible cause of unusual orbital lesions.
|1||Ryan SJ. Ocular cysticercosis. Retina. 2nd edition. St Louis: Mosby 1994 Vol 2, pp 1553-57.|
|2||Shekhar GC, Lemke BN. Orbital cysticercosis. Ophthalmology 1997;104:1599-604.|
|3||Pluschke M, Bennett G. Orbital cysticercosis. Aust NZ J Ophthalmol 1998;26:333-36.|