The Pathological Fear of COVID-19 and Neuroparasitosis: A Case Report of Neurocysticercosis

TL;DR

This case report highlights a patient with neurocysticercosis (NCC) who showed psychiatric symptoms, including fear of COVID-19, and emphasizes the need to consider NCC in behavioral changes.

Contribution

The report emphasizes the under-recognized psychiatric manifestations of NCC and its relevance in differential diagnosis.

Findings

Neurocysticercosis can present with psychiatric symptoms like anxiety and panic attacks.

Treatment of NCC led to resolution of both neurological and psychiatric symptoms in the patient.

NCC's psychiatric manifestations are not well-researched despite being a common CNS infection.

Abstract

Neurocysticercosis (NCC) is an infection of the central nervous system by the helminth Taenia solium (T. solium). The eggs of this parasite are transmitted through the faecal-oral route and by eating contaminated pork. It is currently endemic in many underdeveloped countries and is one of the main treatable risk factors for seizures and epilepsy worldwide. The clinical presentation depends on the location, number and size of the cysts. Neurological symptoms such as headache, epileptic seizures or hydrocephalus are the most common, although neuropsychiatric manifestations associated with this pathology are increasingly being recognised. Diagnosis is based on neuroimaging and serological tests. First-line treatment consists of antiparasitic drugs, corticotherapy and any necessary supportive therapy, such as anti-seizure medication. Despite the availability of treatment worldwide, NCC has been difficult to treat and radiate because its diagnosis depends on ancillary tools that are not widely available in the vast majority of countries where the disease is endemic. As a result, its prevalence is increasing in developed countries, particularly in Europe, with travel and immigration being one of the main factors. We present the case of an 82-year-old patient with a history of psychiatric disorders, who reported episodes of transient dysarthria associated with recent behavioral changes, including periods of anxiety and panic attacks due to fear of contracting COVID-19. Following initial evaluation and complementary examinations, the patient was diagnosed with active NCC. The patient underwent treatment and was discharged asymptomatic, with resolution of the anxiety and panic episodes, even in the context of a COVID-19 infection that occurred during hospitalisation. Although NCC is the most widespread parasitic central nervous system (CNS) disease worldwide, its psychiatric manifestations do not appear to be well-researched in the literature. The aim of this report is to emphasise the inclusion of NCC in the differential diagnosis not only of epileptic seizures and focal neurological deficits but also of behavioral changes.

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