Background: Spinal schistosomiasis is a severe presentation of Schistosoma mansoni infection, which is endemic in South America, the Middle East, and sub-Saharan Africa. With increasing international travel, a disease can spread from an endemic area to another part of the world easily.Objective: To present a case of a US resident who developed acute paraparesis due to spinal schistosomiasis after traveling to sub-Saharan Africa. Participant: A 45-year-old woman presented with abdominal pain radiating into the bilateral lower extremities. She was diagnosed with a pelvic mass and underwent an urgent hysterectomy with right salpingo-oopherectomy. Postoperatively, she developed progressive weakness with worsening pain in her bilateral lower extremities and neurogenic bladder. Magnetic resonance imaging showed an abnormal T2 hyperintense signal in the entire spinal cord below the T3 level with abnormal contrast enhancement from T9 through the conus medullaris. Spinal fluid analysis showed lymphocytic pleocytosis and elevated protein.The patient was diagnosed with transverse myelitis. Subsequently, a detailed history revealed a visit to Ethiopia 2 years earlier. Tests for S mansoni were positive. After treatment with praziquantel and prednisone, her neurologic function began to improve. Conclusions: An increasing incidence of international travel is increasing the likelihood of US physicians' encountering this treatable condition. Travelers with spinal schistosomiasis may not have symptoms of systemic infection. Therefore, it is important to include spinal schistosomiasis in the differential diagnosis of acute inflammatory myelopathy, particularly with a history of travel to endemic areas.
Botulinum neurotoxin A (BoNTA) is rapidly gaining acceptance for management of spasticity secondary to spinal cord injury (SCI). Due to its increased usage, more undesirable effects and complications have come in light. Unwanted distant and/or generalised muscle weakness is possible following BoNTA administration in SCI population causing temporary neurological and functional decline. Physicians should carefuly perform a clinical assessment of every patient individually for risks stratification. Additional studies for adult population evaluating adverse-effects of high dose of BoNTA treatment for spasticity management are indicated. 20 Introduction: S pasticity is a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon responses. 1 It is one of the most common consequences of spinal cord injury (SCI). One year post-injury, about 78% of patients demonstrate spasticity with more than half requiring pharmacological interventions. 2 Botulinum neurotoxin is gaining rapid acceptance for spasticity management due to several advantages. It avoids sedation, common with oral antispasticity medications. No surgical intervention is required. It provides an option of focal spasticity management. It is equally effective as phenol 3 but technically simpler to administer, less painful, and without any side-effects like dysesthesia. Due to its increased usage, more undesirable effects have come in light. Here, I have described a case elucidating distant and generalised muscle weakness as a potential sideeffect of botulinum neurotoxin A (BoNTA) in a patient with SCI with brief literature review.
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