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

Tsinsue Chen, Karam Moon, Daphne E. De Mello, Iman Feiz-Erfan, Nicholas Theodore, Ratan D. Bhardwaj

Research output: Contribution to journalArticlepeer-review

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 0. 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.

Original languageEnglish (US)
Pages (from-to)217-221
Number of pages5
JournalJournal of Neurosurgery: Pediatrics
Volume16
Issue number2
DOIs
StatePublished - Aug 2015
Externally publishedYes

Keywords

  • Cervical infection
  • Onchocerca lupi
  • Parasite
  • Spinal infection
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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