Calcified frontal neurocysticercosis presenting with acute psychosis in a non-endemic context: a case report.

BACKGROUND: Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a widely recognized cause of seizures; nonetheless, its psychiatric manifestations, while recorded, are frequently underdiagnosed, particularly in non-endemic settings. Acute psychosis secondary to NCC is rather uncommon and hard to diagnose, as it often mimics primary psychiatric illness.

CASE PRESENTATION: We report the case of a 23-year-old Indian male living in the United Arab Emirates who presented with two days of confusion, agitation, mutism, disorganized behavior, and persecutory delusions following severe sleep deprivation in a labor camp setting. His history included a previous similar psychotic episode with full remission and two generalized tonic-clonic seizures, the most recent occurring three weeks before admission. On arrival, he exhibited psychomotor abnormalities, intermittent restlessness, and incoherent responses, without focal neurological deficits. Laboratory investigations were unremarkable except for mild lymphocytosis and elevated creatine phosphokinase. CT Brain revealed a 3 mm calcified cortical lesion with perilesional edema in the inferior posterior left frontal lobe, consistent with calcified parenchymal NCC. EEG was normal. He was co-managed by neurology and psychiatry teams and initiated on albendazole, dexamethasone, lamotrigine, risperidone, and lorazepam. His symptoms rapidly improved, with complete resolution of psychosis within four days. Post-discharge MRI in India confirmed a solitary ring-enhancing lesion with central calcification and mild edema compatible with NCC. Upon follow-up, he remained stable with no recurrent seizures or psychiatric symptoms.

CONCLUSION: This case demonstrates acute, reversible psychosis associated with calcified frontal-lobe neurocysticercosis, highlighting the importance of neuroimaging in first-episode or atypical psychosis, particularly in patients from endemic regions or with a history of seizures. Clinical improvement following combined antiparasitic, anti-inflammatory, antiepileptic, and antipsychotic therapy supports the value of early multidisciplinary management, while recognizing that symptom resolution likely reflects multifactorial influences. As global migration increases, clinicians in non-endemic regions should remain aware of NCC as a potential contributor to secondary psychosis.