Occurrence of Autochthonous Neurocysticercosis in Germany: A Case Report

Background 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. Case presentation 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 small, partially hemorrhagic lesions with surrounding edema. Histopathological examination of a brain biopsy revealed granulomatous inflammation with eosinophilic infiltrates and giant cells. Molecular analysis using real-time polymerase chain reaction [RT-PCR] detected T. solium DNA by confirming the diagnosis of NCC. Serological test and stool microscopy for T. solium eggs were negative in both, the patient and her immediate family members. 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 cMRI follow-up examinations showed significant regression of the lesions. Conclusions This case demonstrates a rare case of 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.