Ocular cysticercosis in a 32-year-old man in Abuja: ultrasonic features as an aid in diagnosis
A 32-year-old man from Enugu, South Eastern Nigeria, presented to the Rachel Eye Center in Abuja, Federal Capital Territory of Nigeria, with loss of vision affecting the right eye for a period of 2 months. This was described as a “shadow” in that eye, and was associated with a right-sided headache. He had been to a number of eye care facilities where he had been put on prednisolone tablets and cefuroxime capsules with no change in his status. It later transpired that he had once worked on a pig farm soon after his National Youth Service Corps service about 3 years previously.\nOn examination, his visual acuity was 6/4 and 6/6 R/L, N6 in the right eye and N5 in the left eye. The anterior segment was unremarkable in both eyes. Vitreous reaction in the right eye was 2+ cells. Fundus examination of the right eye revealed a solid-looking elevation of the retina of 3–4 disc diameters in the inferior temporal quadrant of the retina about 1.5 disc diameters high. There was an associated retinal detachment in the lower half of the retina in the form of “undulating water marks”.\nThe B-scan probe was moved from one side of the closed upper eyelid to the other, and some images were acquired by placing the probe on the lower lid as well. B-scan ultrasound in the right eye showed dome-shaped, echogenic, well defined thick membranous structures extending into the vitreous space from the posterior and temporal aspects of the right eye. The membranes were attached in their peripheries to their origins, with their convex sides projecting towards the center of the eye. These membranes were not mobile during the examination. In addition, multiple, small, round echogenic bodies of varying sizes were seen in the submembranous spaces, (later found to be bladder forms of recognizable organisms with suckers). These bodies were also nonmobile.\nThe overall appearance suggested choroidal detachment with submembranous bodies, later discovered to be from ocular cysticercosis. In addition, some slices (, , and ) showed areas of a rather shallow slightly mobile membranous structure extending into the vitreous space, suggestive of a shallow retinal detachment and consistent with the clinical findings on binocular indirect ophthalmoscopy. shows the main features of ocular cysticercosis.\nBecause the main cyst appeared to be a choroidal rather than a retinal detachment, we made the decision to drain the fluid and send it for histopathologic analysis through a radial trans-scleral suprachoroidal incision. Some amber-colored semiviscous liquid was seen. In addition, some cheesy material was also noticed to prolapse from the surgical wound, with subsequent collapse of the choroidal detachment. This was carried out 2 days after presentation. Later on, histologic sections showed a cystic lesion lined by the tegument of an organism. Within the lesions were bladder forms of recognizable organisms with suckers. There was a prominent investing tegument and smooth muscle fibers. The suggested histologic diagnosis was that of ocular cysticercosis.\nThe patient was subsequently started on albendazole and observed. Over the next few weeks, some retinal hemorrhage was noticed over the surgical site, extending to involve the inferior temporal quarter of the fundus. This was later noticed to resorb slowly, leaving some apparently necrotic areas on the retina inferiorly. At this stage, the patient was lost to follow-up.