Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160, Thailand

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Sir,

Cysticercosis is a common tissue parasitic infestation that can be seen in many tropical countries. The cysticercosis can infiltrate in any tissue of the patient, and the infestation can be silent and last long. The diagnosis of cysticercosis is usually by chance. The accidental finding of tissue parasitic cyst and further histopathological examination lead to the confirmation of cysticercosis. Of several infiltration sites, an important site is within central nervous system. This specific kind of cysticercosis is called neurocysticercosis. The neurocysticercosis can lead to several neurological problems, and it can be a deadly medical condition. [1] In general, the patients with neurocysticercosis might present with seizure. Furthermore, the increased intracranial pressure can be seen in the case with obstruction of cerebrovascular fluid flow. The diagnosis of the neurocysticercosis is usually late. The patient usually gets the neurological manifestation, and the neurological imagining investigation is the basic tool that leads to final diagnosis. [1]

However, the neurological problem can be sometimes difficult to diagnose. Some uncommon presentations can lead to difficulty in diagnosis such as the ocular presentation in the recently reported case by Singh et al. [2] Bilateral proptosis in the present case report is very interesting. In fact, cysticercosis can occur at eye and this specific kind of cysticercosis is called ocular cysticercosis. [3] The proptosis can be a presentation of the patient with ocular cysticercosis. However, as Szabo et al. noted, "orbital involvement, in which the parasite localizes within the extraocular muscle is rare". [4] The common sites are "subconjunctival, subretinal and intravitreal structures". [4] In the case with parasitic infestation in orbit, the extraocular muscle involvement can be possible. This can lead to the problem of proptosis. [5],[6] The accompanied symptoms such as strabismus and diminution of vision can be seen. [6] It is no doubt that an important differential diagnosis for proptosis in any patients in the tropical endemic area should cover ocular cysticercosis. However, the neurological problems that can cause proptosis must not be forgotten. Of those neurological problems, in an endemic area, the neurocysticercosis must be included into the differential diagnosis.

The interesting key feature for the case of ocular cysticercosis with orbital involvement and proptosis is the problem is usually unilateral. [5] Hence, the bilateral proptosis as seen in the present case [2] should be sought for the neurological origin of the problem. Nevertheless, the condition that both neurological cysticercosis and ocular cysticercosis occur in the same patient is also possible. The problem of disseminated cysticercosis must be kept in mind in dealing with any cases with identified cysticercosis. [7],[8]

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