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Case Reports
. 2024 Apr 9;86(5):3169-3174.
doi: 10.1097/MS9.0000000000002008. eCollection 2024 May.

Spinal schistosomiasis mimickingspinal tumour: a case report

Yohannis Derbew Molla  1 , Hirut Tesfahun Alemu  2 , Kassa Berie Zegeye  3 , Isak Omer Answar  3 , Samuel Addisu Abera  3 , Girma Damtew Adisu  3 , Dagnachew Akalu Kassie  1 , Almaz Enku Selamawi  4 , Esayas Adefirs Tefera  1
Affiliations
Case Reports

Spinal schistosomiasis mimickingspinal tumour: a case report

Yohannis Derbew Molla et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Schistosomiasis, a parasitic disease, is caused by blood flukes from the schistosoma genus. Neuroschistosomiasis is the most severe form of schistosomiasis, which occurs when the host's brain and spinal cord react to the deposition of eggs, leading to neurological symptoms. Neuroschistosomiasis causes various signs and symptoms, such as myelopathy, radiculopathy, and elevated intracranial pressure.

Case presentation: A 12-year-old child from Ethiopia who presented with progressive weakness in his lower extremities that has been ongoing for 2 months. Alongside the weakness, the patient also experienced tingling sensations and numbness in his lower extremities. Additionally, he had bladder and bowel incontinence. Spinal MRI showed signs suggestive of myxopapillary ependymoma, but the histopathology result showed schistosomiasis. Postoperatively, the patient had a slight improvement in terms of lower extremity weakness (flickering of the digits). However, there was no improvement in his continence ability.

Clinical discussion: The most common neurological manifestation of Schistosoma mansoni infection is myelopathy, which includes subacute myeloradiculopathy and acute transverse myelitis. The cauda equina and conus medullaris are the areas most frequently affected.

Conclusion: When spinal schistosomiasis presents itself as a mimicking spinal tumour, it poses a complex clinical challenge that necessitates a comprehensive interdisciplinary approach to ensure accurate diagnosis and effective treatment. It is imperative for healthcare practitioners to enhance their knowledge and awareness of this uncommon parasitic infection, particularly in regions where it is prevalent.

Keywords: child; mimicking; schistosomiasis; spinal; surgery; tumour; weakness.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
MRI of the patient (sagittal section). Red arrow showed the lesions in the spinal cord.
Figure 2
Figure 2
MRI of the patient (axial section). Red arrow showed the lesions in the spinal cord.
Figure 3
Figure 3
MRI scan showing a 2.4×1.1×1.6 cm eccentrically located intramedullary mass at the conus medullaris. The mass appeared T1 isointense and T2 hyperintense, with avid post-contrast homogenous enhancement. Red arrow showed the lesions in the spinal cord.
Figure 4
Figure 4
Histopathology section of the excised sample showing multiple epithelioid granulomas (arrows). black arrow shows the schistosoma parasite.
Figure 5
Figure 5
Histopathology showing schistosoma eggs surrounded by eosinophils and epithelioid histiocytes. black arrow shows the schistosoma parasite.
Figure 6
Figure 6
Histopathology showing schistosoma eggs surrounded by eosinophils and epithelioid histiocytes. black arrow shows the schistosoma parasite.
Figure 7
Figure 7
Postoperative MRI revealing T1 isointensity and T2 and SPIR hyperintensity, along with post-contrast peripheral and patchy enhancement at the T11 vertebral level of the spinal cord and T9–T12 vertebral level paraspinal soft tissue. Notably, there is an absence of the T9–T12 vertebral spinous process, indicative of postoperative haematoma and paravertebral soft tissue oedema. Red arrow showed the lesions in the spinal cord.
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