Isolated tibialis anterior myocysticercosis without traditional risk factors: Diagnostic differentiation and evidence-based algorithmic management approach

Isolated intramuscular cysticercosis is an uncommon clinical entity, particularly in patients without traditional risk factors such as pork consumption, exposure to pigs, or rural living conditions. We report the case of a 29-year-old female from a metropolitan setting who presented with a painless, firm swelling in the anterolateral aspect of the left proximal leg, without systemic symptoms or history of trauma. Clinical examination was unremarkable aside from the localized swelling. Radiographic findings were normal, but high-resolution ultrasonography revealed a thick-walled cystic lesion within the tibialis anterior muscle with internal echogenic contents and calcific specks. MRI confirmed a fluid-filled lesion with features suggestive of cysticercosis. Serology via ELISA supported the diagnosis, while neuroimaging ruled out neurocysticercosis. The patient was managed conservatively with albendazole (15 mg/kg/day) for three weeks along with NSAIDs. Rapid symptomatic improvement occurred within three days, with complete resolution within a week. Follow-up ultrasonography and MRI confirmed significant regression of the lesion. No recurrence was observed during follow-up. This case highlights the diagnostic challenge posed by isolated myocysticercosis, especially in patients without conventional risk factors. Imaging modalities like ultrasonography and MRI are invaluable in detecting and characterizing such lesions, while serology offers supportive evidence. Albendazole remains the treatment of choice due to its efficacy and safety profile. This case underscores the importance of considering parasitic infections in differential diagnoses of soft tissue swellings and the effectiveness of a non-surgical, evidence-based management approach.