Rare Case of Recurrent Meningitis Due to Neurocysticercosis (P03.251)

Objective: We discuss a case of resistant intracranial and spinal meningitis due to neurocysticercosis. Background Neurocysticercosis of the intracranial and spinal meninges is extremely rare. But this remains an important differential in patients coming from endemic areas. Design/Methods: Case report. We report a case of a young 28 year old girl from Mexico, presenting with symptoms of meningitis. She had recurrent chronic meningitis over more than a year, refractory to treatment with antibiotics and anti-fungals. She had a ventriculoperitoneal shunt placed for hydrocephalus but continued to be symptomatic. Results: CSF studies on several occasions showed high cellularity(predominant lymphocytes), elevated protein in 200s and low glucose(10-20). It failed to grow any organisms. TB PCR was negative. She was HIV negative. MRI brain and spinal cord showed persistent enhancement of the basal meninges and cervical and thoracic leptomeningeal enhancement and cauda equine radiculitis. An anterior epidural abscess with loculations extending from the foramen magnum upto C5 with concern for spinal cord compression at C2 level was seen. She inderwent a cervical spinal decompressive surgery and the dural biopsy showed cysticerci. Also her serum EITB test was positive for neurocysticercosis. She was started on Albendazole and prednisone and showed symptomatic improvement for few months only. There is now concern for worsening cervical cord compression due to thickening of the epidural abscess at the C2 spinal level. Conclusions: Early diagnosis with high index of suspicion for neurocysticercosis is required in endemic areas even when patients present with atypical features like recurrent meningitis with arachnoidits refractory to conventional modalities of treatment. Also this case emphasizes the role of early tissue diagnosis in resistant meningitis as we may miss potentially treatable causes like neurocysticercosis. Disclosure: Dr. Dhamne has nothing to disclose. Dr. Murthy has nothing to disclose.