Misdiagnosed behavior change revealing fatal primitive intra-cerebral echinococcosis

Adv Health Behav,2019,2(1):62-65

DOI:10.25082/AHB.2019.01.005 CASE REPORT

Misdiagnosed behavior change revealing fatal primitive

intra-cerebral echinococcosis

Salem Bouomrani1,2?Karama Rega¨?eg3Nesrine Belgacem1Oussema Souissi1

Mouna Guermazi1,2Sami Krimi3

Abstract:Central nervous system involvement in hydatidosis is rare compared to other somatic local-izations:1-5%.It is schematically divided into two major types:cerebral involvement and spinal involvement.

The brain is a rare localization of hydatid cyst accounting for only2%of all hydatid disease.The psychi-atric manifestations revealing cerebral hydatidosis remain exceptional and often unrecognized and neglected by practitioners despite their potential severity.We report two original observations of fatal cerebral hydatidosis revealed by behavior change(psychomotor agitation,aggressiveness,persecutory delusion,and auditory and visual hallucinations)insuf?ciently explored in two women aged45and17.The possibility of cerebral hydati-dosis must always be evoked in front of any psychiatric symptomatology that remains unexplained in endemic areas for echinococcosis.

Keywords:behavior change,psychiatric manifestations,hydatid cyst,brain hydatidosis,intra-cerebral echinococcosis

1Introduction

Echinococcosis is the most common cestode in the world with a predilection for the Middle East and North Africa.[1–3]It is still one of the so-called“neglected”tropical diseases[1]and represents a real public health problem as well as a heavy socio-economic burden in several countries of the world.[1,3,4]

The world’s major endemic regions are the Mediter-ranean Basin,South America,Asia,including In-dia,Afghanistan,Iran and Turkey;and parts of East Africa.[1–3]Indeed the total number of infested subjects is estimated at2-3million worldwide[5]and the severity of this disease lies mainly in its acute complications(rup-ture,superinfection,anaphylactic shock,etc.)with a risk of sudden death attributed to this parasitosis which re-mains today“serious and not exceptional”.[6]This mor-tality mainly affects young people.[5,6]

Received:April12,2019Accepted:May21,2019Published:May27,2019

?Correspondence to:Salem Bouomrani,Department of Internal medicine,Military Hos-pital of Gabes,Gabes6000,Tunisia;Sfax Faculty of Medicine,University of Sfax,Sfax 3029,Tunisia;Email:salembouomrani@yahoo.fr

1Department of Internal medicine,Military Hospital of Gabes,Gabes6000,Tunisia

2Sfax Faculty of Medicine,University of Sfax,Sfax3029,Tunisia

3Department of Forensic Medicine,Gabes Regional Hospital,Gabes6000,Tunisia

Citation:Bouomrani S,Rega¨?eg K,Belgacem N,et al.Misdiagnosed behavior change revealing fatal primitive intra-cerebral echinococcosis.Adv Health Behav,,2019,2(1):62-65

Copyright:c 2019Salem Bouomrani,et al.This is an open access article distributed under the terms of the Creative Commons Attribution License,which permits unrestricted use,distribution,and reproduction in any medium,provided the original author and source are credited.

Brain localizations are part of the so-called unusual or aberrant localizations of this parasitosis(extra-hepatic and extra-pulmonary)observed in less than10%of cases.[7,8]The psychiatric manifestations revealing cere-bral hydatid cyst remain exceptional and often unrecog-nized and neglected by practitioners despite their poten-tial severity.[9]

We report two original observations of fatal cerebral hydatidosis revealed by behavior change insuf?ciently explored.

2Case1

A woman aged45was found dead in her bed in the morning.Her medical history noted that she had been followed for two months for behavioral disorders,fam-ily aggression,persecutory delusion and auditory and vi-sual hallucinations of progressive installation.No partic-ular personal or family psychiatric history,drug or sub-stance abuse,or any particular addictive behavior was noted.The somatic examination as well as the basic bi-ological tests requested by her psychiatrist revealed no anomalies.The treatment with neuroleptics prescribed by her psychiatrist was ineffective.Given the unex-plained nature of the death,an autopsy was indicated. Postmortem cerebral CT showed a large cerebral mass, of?uid density,intra-parenchymal,supratentorial,occu-pying the left parieto-occipital lobe,resulting in intracra-nial hypertension and subfalcine herniation(Figure1).

Advances in Health and Behaviourc c 2019by Syncsci Publishing.All rights reserved.