Scapular swelling: "subcutaneous cysticercosis unveiled"-a case report

Background: Cysticercosis, a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium, predominantly affects cerebral and ocular tissues. The subcutaneous manifestation of this disease is a relatively uncommon clinical occurrence. Previously very few or no cases of cysticercosis presenting as subcutaneous solitary painful swelling have been reported in the literature. In previous reports, the swelling was described as painless and not solitary.

Case presentation: We present a rare case of subcutaneous cysticercosis in an Indian female in her forties, localized over the left scapular region, exhibiting gradual enlargement over 4 weeks. The patient experienced pain and intense itching without neurological or ocular involvement. Physical examination revealed a well-defined nodular swelling measuring approximately 3.5 cm × 3 cm, painful, nonfluctuating, nonreducible, soft to firm consistency, with no attachment to the underlying muscle, observed at the inferior angle of the left scapula. The overlying skin was tense, glossy, erythematous, and indurated, with mild superficial scaling at a few places and excoriation marks around the swelling. No similar swelling was found elsewhere on the body. The rest of the systemic and physical examination was unremarkable. The clinical diagnosis included an abscess, infected sebaceous cyst, lipoma with inflamed overlying skin, and a remote possibility of subcutaneous cysticercosis. Stool examination for ova, cysts, and parasites was unremarkable. Cysticercus IgG antibody by enzyme-linked immunosorbent assay was negative. A chest X-ray and radiograph of the left scapular region were normal. Fine needle aspiration biopsy of the lesion was planned but could not be completed as the patient did not consent. Local part ultrasonography revealed a well-defined cystic area of 1.9 × 1.1 × 1.6 cm³ (anteroposterior × transverse × craniocaudal) with peripheral calcified streaks (scolex) and surrounding edema suggestive of subcutaneous cysticercosis. The diagnosis was established by the ultrasonography of the lesion suggesting features consistent with cysticercus, and later established by complete resolution after a course of albendazole. Management involved a 3-week course of albendazole and 5 days of paracetamol for pain, leading to the full resolution of swelling and symptoms. On follow-up at 1 month, the swelling had disappeared with no new swelling or symptoms.

Conclusion: Subcutaneous cysticercosis is an unusual presentation of Taenia solium infestation that requires a high index of suspicion for accurate diagnosis. This case report emphasizes the importance of considering parasitic infections in the differential diagnosis of subcutaneous nodules. Early diagnosis and appropriate management are crucial for preventing complications and improving patient outcomes.