Intramedullary spinal schistosomiasis in a child with acute myelopathy: A case report

Abstract

Background: Neuroschistosomiasis is defined as an infection of the nervous system caused by Schistosoma mansoni. Neuroschistosomiasis is an important differential diagnostic consideration in pediatric patients presenting with myelopathy. Surgical excision combined with antiparasitic drugs typically provides a satisfactory outcome and often results in neurological recovery.

Case description: A 4-year-old child presented with acute and progressive myelopathy. A thoracolumbar magnetic resonance image revealed a T12-L2 conus medullaris mass that was isointense on T1 and hyperintense on T2 (with an extensive syringomyelia at the thoracic spinal cord) and showed enhanced heterogeneity with gadolinium. The lesion was excised through T12-L2 laminotomy. Intraoperatively, the tumor appeared reddish and infiltrative. The frozen section suggested a granulomatous process, while the final pathology confirmed conus medullaris schistosomiasis.

Conclusion: Schistosomal myeloradiculopathy should be considered among the different diagnosis in children presenting with lower thoracic region, conus medullaris, and/or cauda equina infiltrative spinal masses.

Keywords: Conus medullaris; Myelopathy; Neuroschistosomiasis; Schistosomiasis; Spinal.

Figure 1:

Preoperative magnetic resonance imaging (MRI). (a) Sagittal view of the lumbosacral spine T1-weighted without contrast showing an isointense signal lesion in the conus medullaris. (b) MRI sagittal view of the T2-weighted lumbosacral spine showing hyperintense conus medullaris signal. (c) Sagittal MRI of the lumbosacral T1-weighted spine after gadolinium injection, heterogeneous contrast enhancing in conus medullaris, an apparently infiltrative lesion. (d) Sagittal section of the dorsal column and lumbosacral showing extensive syringomyelia in the thoracic spinal cord.

Figure 2:

(a-c) Hematoxylin and eosin (H&E) staining showing numerous granulomatous fragments of fibrotic and neural tissue and lymphomononuclear inflammatory infiltrate rich in eosinophils forming granulomatous nodules with necrotic center enclosing parasites with the characteristic spicula of consistent in appearance with Schistosoma mansoni.

Figure 3:

Postoperative magnetic resonance image of the thoracolumbar spine showing the absence of anomalous contrast areas in addition to the absence of recurrence of the lesion.