We thank Dr Oscar H. Del Brutto for his interest in our cysticercosis case and raising the following questions with regard to neuroimaging, antiparasitic, and supportive treatment. Why did the authors use cysticidal drugs if computed tomography (CT) only showed parenchymal brain calcifications? After detection of a Taenia solium scolex in surgically excised subcutaneous tissue the patient underwent CT scans of the brain. The scans showed several parenchymal cystic lesions with partial calcification. Why did they not request for magnetic resonance imaging (MRI) before therapy if they suspected that some viable cysts may be hiding owing to poor resolution of CT? As cystic parenchymal neurcysticercosis with partial calcification was suspected by the radiologist, therapy was initiated according to recent literature (Table in reference 2: cystic parenchymal neurocysticercosis). There is no recommendation to prefer MRI in the examination of suspected neurocysticerosis patients.  Why did they not use antiepileptic drugs? Based on recent literature, steroids should be used concomitantly with antiparasitic treatment in parenchymal neurocysticercosis with the exception of cases with calcification only, in which case no antiparasitic treatment and no steroids should be given. There is no recommendation to use antiepileptic drugs prophylactically in patients without epilepsy. We do not believe that our case may create confusion as we have emphasized that neurocysticercosis should be kept in mind when treating patients with a travel history to T. solium endemic areas, and referred to and discussed recent therapy guidelines.
Robert Krause* and Helmut J.F. Salzer†
*Department of Internal Medicine, Section of
Infectious Diseases and Tropical Medicine, Medical
University of Graz, Graz, Austria; †Department of
Internal Medicine I, Section of Tropical Medicine,
University Medical Center Hamburg-Eppendorf,