Can untreated neurocysticercosis cause anaphylaxis in a patient?

Untreated Neurocysticercosis Does Not Cause Anaphylaxis

Untreated neurocysticercosis does not cause anaphylaxis. This parasitic infection of the central nervous system presents with seizures, increased intracranial pressure, and neurological symptoms related to inflammation around cysts, but anaphylaxis is not a recognized complication of the disease itself 1.

Clinical Manifestations of Untreated Neurocysticercosis

The disease becomes symptomatic through entirely different mechanisms than anaphylaxis:

• Seizures are the most common presentation, occurring in the majority of untreated patients (74-100% in follow-up studies) 1
• Increased intracranial pressure develops from hydrocephalus due to mechanical obstruction of ventricles or inflammatory arachnoiditis 1
• Focal neurological deficits result from mass effect, vasculitis with stroke, or compression of neural structures 1, 2
• Chronic meningitis can occur with subarachnoid cysts, sometimes presenting with eosinophilic meningitis (20% of cases) but not anaphylaxis 1

Important Distinction: Hydatid Cysts vs. Neurocysticercosis

The confusion may arise from hydatid cyst disease (echinococcosis), which is a completely different parasitic infection:

• Hydatid cysts can rupture and cause anaphylaxis, particularly liver cysts rupturing into the peritoneal space 1
• This is caused by Echinococcus granulosus, not Taenia solium (which causes neurocysticercosis) 1
• The risks of anaphylaxis and cyst dissemination with hydatid disease are significant enough that treatment should only occur in specialist centers 1

Pathophysiology of Neurocysticercosis Symptoms

Symptoms in neurocysticercosis result from:

• Local inflammation around degenerating parasites, not systemic allergic reactions 1
• Mass effect from growing cysts or surrounding edema 1, 2
• Immune-mediated inflammation that intensifies when the parasite dies, causing ependymitis, arachnoiditis, or arteritis 2
• Residual scarring and calcifications that serve as epileptogenic foci 1

Clinical Pitfall to Avoid

Do not confuse the exacerbation of neurological symptoms that occurs 2-5 days after starting antiparasitic treatment with anaphylaxis 1. This treatment-related inflammation is:

• Attributed to local inflammation from dying larvae, not systemic hypersensitivity 1
• Controlled with corticosteroids (dexamethasone or prednisone), not epinephrine 1
• Expected and manageable, with fewer than 10 deaths reported among many treated cases 1