Strange Diagnosis: Brain Worms Instead of Cancer
A recent case from doctors in Spain presents a bewildering mix of good and bad news. Initially, they thought their 60-year-old patient had brain cancer, but further investigation revealed he had worms in his head.
The details were outlined in the journal Emerging Infectious Diseases. The patient showed brain lesions that seemed to indicate advanced cancer, but close examination identified them as cysts from the pork tapeworm (Taenia solium). Fortunately, he responded positively to antiparasitic treatment.
The medical team noted, “Our study highlights the diagnostic challenges and risks of local transmission of Taenia solium in areas where it’s not commonly found.”
The Brain Worm
T. solium can affect people in a couple of ways, depending on its transmission method.
If someone consumes undercooked meat from infected pigs or other animals carrying larval cysts, those cysts can develop into adult worms in the gut, leading to the typical gastrointestinal issues associated with tape worms. These adult worms mate and lay eggs that are expelled in feces. Normally, the cycle repeats when pigs eat the contaminated vegetation, but if eggs infect a human, the lifecycle stops at the cyst stage.
Even these cysts can create serious problems, moving to various parts of the body, including the brain. This type of infection is known as cysticercosis, while brain cysts specifically are referred to as neurocysticercosis. Such brain cysts can lead to inflammation and increased pressure inside the skull, which can be dangerous. Although cysticercosis is rare in affluent countries like the U.S. and Spain, it remains a serious concern in less developed areas and is a major cause of seizures worldwide.
The case report mentioned that the patient sought help after experiencing two weeks of worsening headaches and some behavioral changes. A CT scan initially showed lesions that looked like metastatic cancer, and he was placed on dexamethasone, typically used for brain cancer symptoms, leading to his quick improvement.
However, things took a peculiar turn when further tests failed to locate any source of primary cancer. An MRI scan finally revealed the true nature of the brain lesions, and antibody tests confirmed the T. solium infection.
A Happy Ending
As it happened, dexamethasone can help manage inflammation from neurocysticercosis, possibly explaining the patient’s rapid initial improvement. He was given antiparasitic medication, and gradually taken off the steroid without any complications.
This case stands out not only for the misdiagnosis but also because the man and his close contacts hadn’t traveled to areas where the tapeworm is common. Most of his adult life was spent working construction, often sharing meals and facilities with migrant workers from those regions. This suggests he contracted the infection through local exposure, a situation that is deemed extremely rare in Western Europe.
The medical team concluded that neurocysticercosis should be considered in such cases, even in regions where brain cancer is statistically more likely. While having brain worms sounds horrifying, they are generally treatable and seldom fatal. Given the choice, I think I might prefer the worms.
