Parasitosis of the vertebral canal mimicking lumbar intervertebral disc herniation: a case report

STUDY DESIGN: Case report. BACKGROUND: It is a case of dracunculiasis of the spine mimicking lumbar intervertebral disc herniation. CASE PRESENTATION: A 57 year-old Caucasian male was admitted to the hospital because of the left L5 radiculopathy lasting for 2 months. The pain in the left lower limb was associated with muscle weakness on dorsal flexion of the foot, paresthesia of the dorsal aspect of the foot and tingling in the big toe. Neurological examination revealed: muscle weakness on dorsal flexion of the foot, impaired light touch and pin prick test on the dorsal aspect of the foot and positive Lasègue’s sign. Magnetic resonance imaging (MRI) examination revealed L4-L5 intervertebral disc herniation with sequester compressing the left L5 nerve root. The open L4-L5 left side discectomy was performed. During the sequester evacuation 3 pieces of nematodes were removed and preserved in 10% of formaldehyde solution. After the surgery the patient was pain free with normal neurological examination. The diagnosis of dracunculiasis was based on the morphology of the nematode and on exclusion of the other parasites. DM infestation could not be confirmed with molecular testing that was impaired by the formaldehyde. CONCLUSIONS: Parasite infestation should be considered even in cases with obvious MRI of lumbar intervertebral disc herniation. If a nematode was found accidentally during any surgery it should be preserved in a 0.9% saline, not in formaldehyde, not to disturb the molecular tests.