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Serpentine calcification: A radiological stigma

Journal of Neurosciences in Rural Practice
Medknow Publications
Publication Date
DOI: 10.4103/0976-3147.83599
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Sir, A 50-year-old female laborer from a low socioeconomic status came to the neurology outpatient with complaints of back pain. Her past medical history was unremarkable. There was no history of trauma and drug intake. She has been having pain in low back since last year. Pain was diffuse, mild with no radiation and parasthesia. On examination, there was no tenderness; straight leg raising test was 75° in both lower limbs. Power was grade 5/5, reflexes 2+ and plantar flexor. Sensory system examination was normal. Routine biochemistry was not contributory. Plain radiograph of the lumbar spine view showed two soft tissue calcification in the paraspinal muscles extending from L2-5 vertebra [Figure 1]. The calcification was long, linear-beaded and fragmented in appearance. A diagnosis of guinea worm calcification was made. Patient was reassured and maintained on symptomatic treatment. She is asymptomatic on 1 year follow-up. Figure 1 Plain radiograph of the lumbar spine view showed two soft tissue calcification in the paraspinal muscles extending from L2-5 vertebra. Dracunculosis or guinea worm disease, a preventable infection caused by the parasite Dracunculosis Medinensis (DM) is transmitted by drinking water containing copepods (water fleas) that are infected with DM larvae. The worm survives the digestive enzyme in the stomach and after 1 year the female migrates to the surface of the body producing a blister on the skin. If the worm does not reach the skin at all, it disintegrates or becomes calcified which can be seen on the X-ray. The muscle movement causes breaking up of the calcified worm rendering a beaded appearance. The localization and the characteristic appearance of the calcifications in the patient were diagnostic of guinea worm calcification Guinea worm calcification may take several forms. Typically it calcifies in the lower extremities, where it assumes a long string like serpenginous or curvilinear calcification which may be very l

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