Letters to the Editor: Radiological, parasitological, and biological considerations regarding alleged adult Taenia solium brain infection

We are concerned that the conclusions drawn by the authors are erroneous.This clinical case presents several pitfalls that do not favor the diagnosis of cerebral localization of an adult form of Taenia solium.The authors present three MRI studies performed at T0, T + 5 months, and T + 3 years.It is unclear whether the patient received specific treatment during this period.As no cases of adult T. solium in the brain have been described previously, we cannot discuss the images from this perspective.We can only state that these images are clearly not consistent with the larval form of T. solium.Indeed, as described by the authors, we observe an irregular lesion, enhanced by contrast, with perifocal edema.The irregular shape is unusual.In both sets of diagnostic criteria for neurocysticercosis (NCC), cysticercosis lesions are described as "round, cystic, fluid-filled lesions" 2 and as "circumscribed, rounded." 3 Furthermore, the migratory nature of the lesion does not occur in cases of NCC.In contrast, these images are entirely consistent with those described in cases of cerebral sparganosis.Indeed, they are characterized by multilocular lesions with contrast enhancement, and the migration of these lesions is a distinctive feature. 4,5he "eggs" in Fig. 3 do not appear to be cestode eggs: they are too irregular in shape and size, and the "striations" characteristic of the taeniid embryophore are external rather than appearing to be internal in the illustration provided.The structures in the figure may be calcareous corpuscles, but not eggs.To establish a morphological identification of T. solium, it would be necessary to show that a scolex was present with the characteristic number and sizes of rostellar hooks. 6The claim that it represents a gravid specimen would need to be supported with a stained or cleared region of the strobila showing proglottids with a characteristically branched uterus or even developing genital organs. 7Without such information, the specimen in Fig. 2 cannot be distinguished from other metacestodes such as plerocercoids of Spirometra sp.Finally, the hypothesis that the patient's immunosuppression allowed an adult T. solium to migrate from the intestine to the brain, crossing both the intestinal barrier and the blood-brain barrier, is biologically implausible.