A Rare Case of Submental Cysticercosis Presenting As An Abscess

A RARE CASE OF SUBMENTAL CYSTICERCOSIS PRESENTING AS AN ABSCESS Dr. Suganshi Garg, Dr. Nagaraj B T Introduction: Cysticercosis is a parasitic infection caused by larvae of the tape worm Taenia Solium. Extraneural lesions are solitary and rare usually involving subcutaneous tissue, skeletal muscles and eyes. Mimics other soft tissue lesions. Subcutaneous form of the disease is a rare clinical entity. In this report we aim to describe a case of submental cysticercosis presenting as an abscess, diagnosed with high resolution ultrasound findings. Case presentation: A 54 year old woman reported to the hospital with a swelling in the submental region since 4 months associated with pain. On Physical Examination there was a large, well defined, tender, soft, mobile, cystic swelling with inflammatory changes of the overlying skin suggestive of a soft tissue abscess. There was no associated discharge. Rest of the ENT examination was normal. High resolution ultrasound showed a well defined, thin-walled, cystic lesion with an eccentric, echogenic focus in the subcutaneous plane. The hypoechoic area surrounding the cyst showed significant exudative fluid collection. The adjacent soft tissues were thickened and irregular suggestive of oedema. Histopathological examination revealed cysticercus cellulose parasite with an extensive mixed inflammatory cell infiltrate in the surrounding tissue. The patient was also administered oral antihelminthic therapy. Repeat ultrasound at the end of the management regimen showed complete healing without evidence of any remnant or recurrent cystic lesion, abscess or oedema in the subcutaneous plane. Discussion: Treatment of soft tissue cysticercosis depends on the location of the cysts. Surgical excision is done for isolated skeletal muscle or soft tissue cysticercosis associated with abscess. Cysticercosis, thus, should always be a part of differential diagnosis of subcutaneous swellings in India. Ultrasound is a good modality for diagnosing soft tissue cysticercosis. Conclusion: Subcutaneous cysticercosis is a relatively rare form of cysticercosis but should always be born in mind during the evaluation of subcutaneous swellings. In classic cases with a cyst containing a scolex within and with a surrounding abscess, high resolution ultrasound should always be the primary mode of diagnosis, thus avoiding unnecessary fine needle aspiration cytologies.