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Doctors suspected man had brain cancer. He actually had worms
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- DeepHorus
In a surprising medical case in Spain, a 60-year-old man who was initially suspected of having metastatic brain cancer was instead found to be infected with tapeworm larvae. The man sought medical attention for a persistent headache that had worsened over two weeks, accompanied by subtle behavioral changes. Doctors at a Spanish hospital conducted a neurological exam, which revealed only a mild delay in his movements, and his blood work showed elevated IgE levels—a marker often linked to allergies, autoimmune diseases, or parasitic infections. A computed tomography (CT) scan of his head revealed multiple lesions with swelling, leading the medical team to suspect cancer as the most likely diagnosis.
The patient was not immunocompromised and had never traveled internationally, which further supported the cancer hypothesis. To manage his headache, doctors prescribed an anti-inflammatory corticosteroid, which provided relief. They then embarked on an extensive search for a primary cancer, including a whole-body contrast-enhanced CT scan, a colonoscopy, and a hybrid positron emission tomography/CT scan. Despite these thorough investigations, no malignancies were found anywhere in his body.
A subsequent magnetic resonance imaging (MRI) scan of the brain provided the critical clue. The detailed images revealed that the lesions were not tumors but encapsulated tapeworm larvae, specifically the heads (scoleces) of pork tapeworms (Taenia solium). This condition, known as neurocysticercosis, is caused by larval cysts in the brain and is a leading cause of acquired epilepsy in endemic regions. The finding was unexpected because tapeworms are not endemic to Spain, and the patient had not traveled abroad.
Doctors speculated that the man might have been exposed to the parasite through his work. Until his retirement 10 years prior, he had worked in construction alongside migrants from regions where Taenia solium is endemic, such as parts of Latin America, Africa, and Asia. The tapeworm spreads via the fecal-oral route, often through contaminated food or water. The man’s doctors proposed that he might have contracted the infection through cryptic transmission—possibly by sharing meals or bathrooms with a coworker who had an active tapeworm infection.
The case highlights the diagnostic challenges neurocysticercosis presents in non-endemic areas. Symptoms such as headaches, seizures, and behavioral changes can mimic brain tumors or other neurological disorders. Elevated IgE levels, while nonspecific, can sometimes point to parasitic infections. The doctors noted that the patient’s lack of travel history and immunocompetence initially steered them away from considering a parasitic cause.
Published in the journal Emerging Infectious Diseases, the case report underscores the importance of considering rare etiologies when common diagnoses are ruled out. The doctors expressed surprise at the findings and emphasized that neurocysticercosis should be included in the differential diagnosis for patients with brain lesions, even in non-endemic countries, especially if they have potential exposure to infected individuals. The patient was treated with antiparasitic medications and corticosteroids, and his symptoms improved.
This case serves as a reminder that globalization and migration can introduce infectious diseases to new regions. Public health officials may need to increase awareness of neurocysticercosis among clinicians in non-endemic areas. As travel and migration patterns continue to evolve, such atypical presentations may become more common, requiring a broad diagnostic approach to avoid misdiagnosis and ensure appropriate treatment.
