BMJ Case Reports 2017; doi:10.1136/bcr-2017-222281
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A fatal case of malignant neurocysticercosis

  1. Kwee Choy Koh2
  1. 1Radiology Department, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
  2. 2Department of Medicine, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
  1. Correspondence to Dr Sidney Ching Liang Ong, sidney_ong{at}
  • Accepted 15 September 2017
  • Published 27 September 2017


A 43-year-old Muslim woman presented with intermittent fever, lethargy, poor appetite and weight loss for a month and altered behaviour for a week. She had a holiday trip to the provincial town of Hat Yai in South Thailand 7 months prior where she had eaten pork-free street food. On admission, she was confused, lethargic and not obeying command. There was no motor deficit.

Septic workup for bacterial and fungal infections was negative. Cerebrospinal fluid analysis showed pleocytosis with a negative tuberculosis (TB)-PCR result. IgG serology for HIV, Toxoplasma gondii and Taenia solium was negative.

Initial CT brain showed white matter hypodensities at bilateral frontoparietal regions. Several small peripherally enhancing parenchymal lesions seen on contrast-enhanced CT. These lesions were well circumscribed with no calcification or soft-tissue component. No hydrocephalus was seen.

MRI brain later revealed multiple small rim-enhancing cystic lesions in the basal ganglia, grey–white …

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