|Year : 2023 | Volume
| Issue : 2 | Page : 516-518
Migration of inferior rectus muscle orbital cysticercosis to anterior subcutaneous tissue
Shailly Tyagi, Sandeep Kumar, Vandana Kohli
Department of Ophthalmology, ESI PGIMSR, Basaidarapur, New Delhi, India
|Date of Submission||27-Jul-2022|
|Date of Acceptance||04-Dec-2022|
|Date of Web Publication||28-Apr-2023|
Department of Ophthalmology, ESI PGIMSR, Basaidarapur, New Delhi - 110 015
Source of Support: None, Conflict of Interest: None
We report an unusual presentation of ocular cysticercosis in a 30 year old female who presented with diplopia and hypertropia of left eye for 1 month, wherein cysticercus cellulosae cyst was found within the mass of the left inferior rectus muscle. After 7 days of presentation, the diplopia and corresponding hypertropia recovered on its own as the cysticercus migrated spontaneously to the subcutaneous tissue of the lower eyelid. It becomes important to report this case because of the rarity of the migration of cysticerci from the muscle in orbit to the subcutaneous tissue in the eye, which in itself is an unusual presentation.
Keywords: Cysticercosis, inferior rectus, orbital, subcutaneous
|How to cite this article:|
Tyagi S, Kumar S, Kohli V. Migration of inferior rectus muscle orbital cysticercosis to anterior subcutaneous tissue. Indian J Ophthalmol Case Rep 2023;3:516-8
|How to cite this URL:|
Tyagi S, Kumar S, Kohli V. Migration of inferior rectus muscle orbital cysticercosis to anterior subcutaneous tissue. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 4];3:516-8. Available from: https://www.ijoreports.in/text.asp?2023/3/2/516/374905
Cysticercosis is one of the most serious parasitic infections spreading almost all over the world and listed as one of the neglected tropical diseases., Cysticercus cellulosae, the larval form of the pork tapeworm Taenia solium, is the causative organism of cysticercosis, in which humans are the intermediate hosts in the life cycle. Human cysticercosis occurs by ingesting the eggs of T. solium from contaminated food and water. The human then becomes an accidental intermediate host. Cysticercosis is endemic to regions with poor sanitation. With the improved living and hygienic conditions, the incidence of human cysticercosis is decreasing these days. However, such cases are still occasionally seen, the main sites of such cysts being skeletal muscles and subcutaneous tissues. The involvement of the eyeball and orbit is uncommon. Ocular cysticercosis may be extraocular (in the subconjunctival or orbital tissues) or intraocular (in the vitreous, subretinal space, or anterior chamber).,,
| Case Report|| |
A 30 year old female presented to the eye outpatient department (OPD) of ESIC Model Hospital, Basaidarapur, New Delhi, India, with the complaint of diplopia for 1 month [Figure 1].
There was diplopia, but no complaint of any diminution of vision, or pain during eye movements. On inspection, left eye hypertropia was noted with limitation of movement of left eye in downgaze. Head posture was normal, eyebrows were on equal level, and frontal crease was present. There was no proptosis. Extraocular movements were limited in inferior gaze in the left eye. Slit-lamp examination of the anterior segment was normal. Fundus seen under full mydriasis was normal. Regional lymph nodes were not enlarged. Intraocular pressure was within normal range. Levator palpabrae superioris action was good. Right eye was normal on examination. A provisional diagnosis of left inferior rectus lesion was made. General examination revealed no other abnormality. Ultrasound (USG) orbit of left eye was done the same day, and it showed a well-defined cystic lesion in the inferior rectus muscle with a high reflective structure within the cyst, suggestive of scolex [Figure 2].
|Figure 2: USG showing cyst with scolex in the inferior rectus muscle. USG = ultrasound|
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A definitive diagnosis of left inferior rectus cysticercosis was made. Patient was planned for a magnetic resonance imaging (MRI) of brain and orbit before starting albendazole. MRI was done [Figure 3] and report was awaited.
|Figure 3: MRI orbit showing cysticercus in the inferior rectus muscle of left eye. MRI = magnetic resonance imaging|
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In the meanwhile, patient came again after 2 days with the complaint of swelling in left lower lid. On examination, a firm, cystic, nontender mass, about 2 × 1 × 1 cm, was noted in the left lower lid. It was not attached to the skin or the underlying tissue and was noncompressible and nonreducible [Figure 4].
A noteworthy finding here was that hypertropia was absent now and no limitation of movement was there. An immersion USG was done for the swelling, which revealed a cyst with scolex in the lower lid subcutaneous tissue. USG orbit showed no cyst in the inferior rectus muscle, where it was seen previously. Hence, a diagnosis of migrating orbital myocysticercosis was made [Figure 5].
Routine investigations were normal, except eosinophilia. Enzyme-linked immunosorbent assay (ELISA) done for anticysticercal antibodies in serum was positive. Other laboratory investigations were noncontributory. B-scan ultrasonography findings were as described previously. MRI showed left inferior rectus muscle with a well-defined cystic lesion with eccentric enhancing nodule. There was no evidence of neurocysticercosis (NCC), and the involvement of brain was ruled out with MRI. A diagnosis of inferior rectus ocular cysticercosis of the left eye with migration was made.
After confirming on MRI that there was no NCC, patient was put on medical treatment, that is, oral albendazole (15 mg/kg/day) in two divided doses and oral prednisolone (1 mg/kg/day) for 4 weeks. After 4 weeks, oral albendazole was stopped and oral prednisolone was slowly tapered over the next 1 month. Patient showed signs of improvement, and the swelling started regressing.
Patient was regularly followed up in the OPD. After 1 month, there was significant resolution in the condition and was also confirmed on B-scan. MRI done 5 months after treatment showed no cystic lesion or nodule or any new lesion in the orbit or brain [Figure 6].
| Discussion|| |
Orbital cysticercosis can present with varied signs and symptoms like acquired strabismus, diplopia, recurrent redness, and proptosis. It has to be differentiated from other benign and malignant conditions presenting as ocular mass. One or more extraocular muscles may be simultaneously involved. There are few case reports describing spontaneous extrusion of cysticercosis from the subconjunctival space. In another report, an unusual association of multiple brain NCC with ocular cysticercosis involving levator palpebral superioris and superior rectus muscle has been reported.
| Conclusion|| |
In our case, the cyst was present within the inferior rectus muscle and migrated later anteriorly to the subcutaneous tissues, which has not been described in literature. From this point of view, the case report is interesting and unusual. Prompt diagnosis and treatment in this case led to an early improvement. Public health measures on a large scale are required for eradication of this disease from the area.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Budke CM, White Jr AC, Garcia HH. Zoonotic larval cestode infections: Neglected tropical diseases? PLoS Negl Trop Dis 2009;3:e319.
Flisser A, Craig PS, Ito A. Cysticercosis and taeniosis: Taenia solium, Taenia saginata and Taenia asiatica. In: Palmer SR, Soulsby LPR, Torgerson PR, Brown DWG, editors. Oxford Textbook of Zoonoses. Oxford: Oxford University Press; 2011. p. 625-42.
Murthy GR, Rao AV. Sub-conjunctival cysticercosis. Indian J Ophthalmol 1980;28:77-8.
] [Full text]
Ziaei M, Elgohary M, Bremner FD. Orbital cysticercosis, case report and review. Orbit 2011;30:230-5.
Rath S, Honavar SG, Naik M, Anand R, Agarwal B, Krishnaiah S, et al.
Orbital cysticercosis: Clinical manifestations, diagnosis, management, and outcome. Ophthalmology 2010;117:600-5.
Verma R, Jaiswal A. Multiple brain parenchymal neurocysticercosis with extraocular muscle cysticercosis affecting levator palpebral superioris and superior rectus complex: An unusual association. BMJ Case Rep 2013;25:bcr2012007421.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]