Pomegranate Seed–Like Appearance of Spinal Sparganosis

A 45-year-old man presented with urinary retention and progressive bilateral lower limb weakness (left 3/5, right 1/5) over 3 months.MRI showed multiple nodular and pomegranate seed-like lesions filling the spinal canal from T11 to L5 (Figure , A andB).He occasionally ate raw fish, but blood eosinophil count and stool examination were unremarkable.Lumbar puncture failed because of lesions occupying the subarachnoid space.The preliminary diagnosis was an intraspinal tumor, but intraoperative findings showed diffuse yellowish necrotic tissue (Figure ,C).Histopathologic examination revealed necrotic parasite bodies (Figure ,D) and calcareous corpuscles of worms without tumor cells (Figure ,E).Subsequent CSF obtained through thoracic subarachnoid puncture under X-ray guidance was analyzed using metagenomic next-generation sequencing, identifying 36,816 sequence reads aligned to the Spirometra mansoni genome.Sparganosis is endemic in Asia and usually acquired through consumption of raw frogs or fish, or copepods-contaminated water. 1,2The patient received praziquantel (50 mg/kg/d), with symptom improvement at 6-month follow-up.