Cerebral Cysticercosis Manifesting 20 Years after Primary Cutaneous Disease

By Oscar H. Del Brutto

Affiliations

School of Medicine and Research Centre, Universidad Espiritu Santo Ecuador, Samborondon, Ecuador

doi: 10.29271/jcpsp.2026.06.837

Sir,

I read a recent case report published in J Coll Physicians Surg Pak, describing a patient with a subcutaneous cysticercus lesion biopsied three decades ago, followed by the development of a cerebral cysticercosis.¹ While the clinical chronology is intriguing, it was probably related to a single infection with metacestodes travelling to both the subcutaneous tissues and the central nervous system or, most likely, due to two different sequential infections years apart (which is possible if an individual resides in an endemic setting). I am concerned by the authors’ suggestion that incomplete excision of sub- cutaneous cysticerci may allow parasitic membrane rem- nants to travel to the brain and implant there.

This assertion represents a severe misinterpretation of the pathophysiology of Taenia solium infections. Neurocysticercosis results from haematogenous dissemination of oncospheres following ingestion of T. solium eggs, not from migration of subcutaneous larval cysts post-biopsy. Once a cysti-cercus has developed in subcutaneous tissue, it is already a terminal-stage larva; it cannot re-enter circulation or migrate to other organs, even if surgically manipulated. Suggesting otherwise risks confusing readers and may inadvertently promote unnecessary surgical interventions or misinformed clinical decisions.

Moreover, the implication that biopsy techniques could influ-ence central nervous system involvement lacks biological plausibility and is unsupported by current parasitological understanding.² If the authors intended to highlight the importance of complete excision for diagnostic or symptomatic reasons, that point should be clarified without attri-buting migratory potential to mature cysticerci.

I respectfully urge the editorial team to consider a clarifica- tion or editorial note to prevent misinterpretation. Case reports are valuable for hypothesis generation, but they must be anchored in established pathophysiology to avoid mislead- ing readers—particularly in regions where cysticercosis remains endemic and clinical decisions may hinge on such publications.

COMPETING INTEREST:
The author declared no conflict of interest.

AUTHOR’S CONTRIBUTION:
OHDB: Conceptualised, wrote the original draft, and approved the final version of the manuscript to be published.

REFERENCES

Cui Y, Wang B. Cerebral cysticercosis manifesting 20 years after primary cutaneous disease. J Coll Physicians Surg Pak 2025; 35(8):1073-4. doi: 10.29271/jcpsp.2025.08.1073.
Garcia HH, Gonzalez AE, Gilman RH. Taenia solium cysticercosis and its impact on neurological disease. Clin Microbiol Rev 2020; 33(3):e00085-19. doi: 10.1128/CMR. 00085-19.

Authors Reply Section

By Yang Cui

Affiliations

Dr. Yang Cui, Department of Neurosurgery, Hebei Yanda Hospital, Sanhe City, Langfang, Hebei, China

AUTHOR'S REPLY:

Sir,

Thank you for your valuable feedback. I fully agree with your insights on the pathophysiological process of parasites within the human body. This case is relatively rare in clinical practice, involving the discovery of brain parasites after an initial skin parasite infection, which raised our attention due to the long interval between the two occurrences. In response to concerns raised, the following clarification is provided. The patient's initial infection may have included undetected skin infections and related treatments, which the patient cannot clearly recall. If other undiscovered parasites were not completely treated, new eggs could potentially enter the brain, suggesting that the infection might not be limited to the known subcutaneous adult worms, but could also involve other eggs that were not detected. The patient resides in Northeast China, an area not typically associated with high rates of parasitic diseases. The possibility of a secondary infection due to residing in an endemic area is unlikely. The possibility of the patient having a multi-organ infection involving both the skin and the brain during the initial infection has also been considered. However, during the period in question, the patient underwent brain imaging, which did not show any signs of brain parasites. The fact that brain parasites were discovered decades later is indeed rare. After decades of parasitic disease history, the discovery of brain parasites indicates that there were likely larvae or eggs in the patient's body. We apologise if our previous communication was unclear, leading to the misunderstanding that the brain parasites were caused by subcutaneous adult worms.

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Cerebral Cysticercosis Manifesting 20 Years after Primary Cutaneous Disease

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Journal of the College of Physicians & Surgeons Pakistan