Neuroschistosomiasis: A Case Report and Review of Literature

Abstract

Spinal cord involvement is a rare complication of the schistosomiasis manifesting as myeloradiculopathy, medullary or conus-cauda equina syndrome which can lead to potentially serious long-term disability. Computed tomography and magnetic resonance imaging coupled with biochemical parameters have become the mainstay of diagnosis. Biopsy which is the gold standard of diagnosis demonstrating the organism is usually reserved for cases of diagnostic challenge. We report a rare case of upper thoracic spinal cord schistosomiasis diagnosed by biopsy in an 18-year-old male migrant presenting to a spine and orthopaedic centre in Ghana with complaints of upper back pain and associated myeloradiculopathy symptoms. Initial suspicion of intramedullary cord tumour was made based on magnetic resonance imaging findings warranting biopsy which revealed schistosoma spp. He was treated with anthelminthics and corticosteroids with a resolution of symptoms.

Keywords: Anthelminthics; back; corticosteroids; myeloradiculopathy; pain; schistosomiasis; spinal cord; thoracic.

Figure 1

Magnetic resonance imaging showing signal changes at C5–C7 and an intramedullary mass at T2–T5

Figure 2

Intraoperative photo showing durotomy

Figure 3

(a and b) Schistosoma ova (with terminal spine) at 40× and 400× magnification respectively (haematoxylin and eosin staining). (c) Ova inciting granulomatous inflammation (magnification—40×). (d) background of lymphoplasmacytosis (magnification—200×) (haematoxylin and eosin staining)