Title

Case report of an epidural cervical Onchocerca lupi infection in a 13-year-old boy.

Department

Neurosurgery

Document Type

Article

Abstract

A 13-year-old boy presented with fever and neck pain and stiffness, which was initially misdiagnosed as culture-negative meningitis. Magnetic resonance images of the brain and cervical spine demonstrated what appeared to be an intradural extramedullary mass at the C1-3 level, resulting in moderate cord compression, and a Chiari Type I malformation. The patient underwent a suboccipital craniectomy and a C1-3 laminectomy with intradural exploration for excisional biopsy and resection. The lesion containing the parasite was extradural, extending laterally through the C2-3 foramina. Inflammatory tissue secondary to Onchocerca lupi infection was identified, and treatment with steroids and doxycycline was initiated. At the 6-month follow-up, the patient remained asymptomatic, with MR images demonstrating a significant reduction in lesional size. However, 10 weeks postoperatively, the infection recurred, necessitating a second operation. The patient was treated with an additional course of doxycycline and is currently maintained on ivermectin therapy. This is the second reported case of cervical O. lupi infection in a human. In the authors' experience, oral doxycycline alone was insufficient in controlling the disease, and the addition of ivermectin therapy was necessary.

Medical Subject Headings

Adolescent; Arnold-Chiari Malformation; Cervical Vertebrae; Craniotomy; Doxycycline; Filaricides; Humans; Ivermectin; Laminectomy; Magnetic Resonance Imaging; Male; Onchocerciasis; Spinal Cord Compression

Publication Date

8-1-2015

Publication Title

J Neurosurg Pediatr

ISSN

1933-0715

Volume

16

Issue

2

First Page

217

Last Page

221

PubMed ID

25932778

Digital Object Identifier (DOI)

10.3171/2014.12.PEDS14462

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