# Occurrence of autochthonous neurocysticercosis in Germany: a case report

## TL;DR

A rare case of autochthonous neurocysticercosis in Germany is reported, highlighting diagnostic challenges in non-endemic regions.

## Contribution

This is a rare report of autochthonous neurocysticercosis in Western Europe without travel or livestock exposure.

## Key findings

- A 43-year-old German woman presented with seizures and MRI findings consistent with neurocysticercosis.
- Molecular analysis confirmed Taenia solium DNA in brain tissue despite negative serology and stool tests.
- The patient responded well to antiparasitic and anticonvulsive treatment with lesion regression observed.

## Abstract

Neurocysticercosis [NCC] represents a severe manifestation of parasitic infection of the central nervous system [CNS] by larvae of Taenia (T.) solium, the pork tapeworm. Although it is one of the main causes of acquired epilepsy worldwide, endemic transmission in Europe has been largely eliminated, with only isolated autochthonous cases occurring.

A 43-year-old woman from a rural region in Saxony-Anhalt, Eastern Germany, with no history of travel abroad or contact with livestock or known tapeworm carriers presented with a first-time generalized epileptic seizure. Cranial magnetic resonance imaging [cMRI] showed multiple ring-enhancing lesions with surrounding edema and calcifications. Histopathological examination of a brain biopsy raised suspicion of a parasitic infection based on granulomatous inflammation with eosinophilic infiltrates, giant cells, and amorphous material. Subsequent molecular analysis using real-time polymerase chain reaction [PCR] detected T. solium DNA. Neoplasms and alternative (granulomatous) diseases were excluded. Serological testing and stool microscopy for T. solium eggs were negative in both the patient and her immediate family members. The definitive diagnosis of NCC was established. Antiparasitic treatment with albendazole and praziquantel in combination with corticosteroids was initiated and anticonvulsive therapy was continued. The patient remained seizure-free during follow-up, and repeated cMRI showed significant regression of the cerebral lesions.

This case demonstrates a rare case of highly suggestive autochthonous NCC in Western Europe and highlights the diagnostic challenges in non-endemic regions, as well as the importance of considering NCC in the differential diagnosis of patients presenting with typical symptoms such as seizures and NCC-compatible findings in neuroimaging, even if the medical history does not suggest transmission of T. solium. Strengthening awareness among physicians and improving diagnostic tools for direct pathogen detection are crucial to enable timely diagnosis even in cases of negative serology.

Not applicable.

The online version contains supplementary material available at 10.1186/s12879-026-12859-w.