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Doctors Expected a Brain Tumor. It Was a Tapeworm

Debbie Koenig
June 11, 2019

Rachel Palma had been having odd symptoms for months — hallucinations, dropping things, trouble speaking. Her many visits to the emergency room didn't solve things. Finally, a brain scan revealed what seemed to be the cause: a marble-sized tumor. In September 2018, doctors at Mount Sinai Hospital in New York City scheduled Rachel for surgery, expecting to find cancer.

"We did a small dissection of the brain tissue, and what we saw was a very well encapsulated, firm lesion that was ovoid," Jonathan Rasouli, MD, chief resident of neurosurgery at Mount Sinai, told CNN. "It looked like a quail egg: Same size, same look, same firmness."

When they sliced it open under a microscope, they found a baby tapeworm.

After living with the idea of malignant brain cancer, a parasite turned out to be a relief for Palma, 42, of Middletown, NY. "Of course I was grossed out," she told The Washington Post. "But of course, I was also relieved. It meant that no further treatment was necessary."

Doctors diagnosed Palma with neurocysticercosis, a parasitic infection of the brain that can happen if you swallow the microscopic eggs of the pork tapeworm. It can cause seizures and even death.

So how does the infection happen? Those itty-bitty eggs pass through the body of someone who carries an intestinal adult tapeworm infection, via their feces. If that person doesn't wash their hands properly, they can contaminate surfaces and food with the eggs. After someone else swallows them, the eggs hatch and travel to the brain, where they become larvae. When larvae are in the brain, it's called neurocysticercosis.

In the United States, acquiring neurocysticercosis is incredibly rare — the tapeworm larvae aren't found in pork here, so the carrier must have been exposed outside the U.S., says Christina Coyle, MD, a parasitology expert in the Department of Medicine at Albert Einstein College of Medicine, who helped write the most recent diagnosis guidelines. Only about 1,000 cases a year require hospitalization, and most are in people who immigrated from endemic areas such as Asia, Africa, Mexico, and other parts of Latin America. Because it's so rare, health care providers may not be familiar with it, according to the CDC.

"The suspicion of neurocysticercosis in someone who hasn't traveled is low," says Coyle. "We're talking about a handful of people who've acquired it in the U.S."

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Reviewed on 6/12/2019
References
SOURCE: Medscape, June 11, 2019. CNN: "Unusual symptoms pointing to brain cancer turned into something completely different." World Health Organization: "Taeniasis/cysticercosis." CDC: "Neurocysticercosis." The Washington Post: "Surgeons opened her skull to remove a cancerous tumor. Instead, they found a tapeworm." Christina Coyle, MD, Department of Medicine, Albert Einstein College of Medicine, New York City.

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