Neuroschistosomiasis mimicking lower back pain: case report of a rare differential diagnosis in a pediatric patient

Abstract

BackgroundSpinal myelitis is an infrequent manifestation of spinal cord infection. It is caused by the Schistosoma species, which are endemic in South America, part of the Middle East, and Africa.Case presentationWe report the case of a 13-year-old male adolescent complaining of progressive lower back pain and weakness of the lower extremities for 3 days. Initial magnetic resonance imaging revealed typical transverse myelitis. Subsequently, parasite serology showed a markedly elevated level of Schistosoma antibody titers, and cerebrospinal fluid analysis yielded normal results. Because of our presumptive diagnosis of neuroschistosomiasis, the patient was prescribed an empirical regimen of an anti-parasitic agent, after which his neurological deficit promptly subsided. The patient was followed for 1 year and showed a complete long-term resolution of symptoms.ConclusionsThis case highlights the increasing prevalence of neuroschistosomiasis in recent years, particularly in patients with a history of travel to endemic regions. Moreover, the study reports the clinicoradiological features of this enigmatic disorder. This rare occurrence potentiates further studies to address unanswered questions about neuroschistosomiasis.

Medullary neuroschistosomiasis in a pediatric patient: a case report

“…Schistosomiases may enter the CNS via two major pathways. Adult worms may migrate and deposit eggs in the CNS or parasitic eggs may travel via either the arterial or venous system, especially the valveless peri-vertebral venous plexus of Batson [ 6 , 7 ]. This plexus connects the deep iliac veins and inferior vena cava with the spinal cord veins [8] .…”

“…This plexus connects the deep iliac veins and inferior vena cava with the spinal cord veins [8] . Schistosomiasis in the spine has four standard clinical forms, namely, granulomatous, myelitis, radicular or vascular [6] . The schistosomiasis eggs release proteolytic enzymes that induce inflammation, leading to the eventual formation of granulomas [9] .…”

A Case of Neuroschistosomiasis Presenting as Transverse Myelitis: The Importance of History Taking

“…Schistosoma eggs usually induce a local eosinophilic inflammation resulting from the release of proteolytic enzymes. The resultant inflammation causes damage and granuloma formation, and eventually fibrosis and demyelination of the surrounding structures [ 6 ].…”

“…A definite diagnosis is made by tissue biopsy. Serology is a sensitive test for the diagnosis, but with high false-positive rates, they are sometimes considered un-reliable, however, positive test results with high titers (>1:160) are considered significant [ 6 , 9 ].…”

Cerebral neuroschistosomiasis presenting as a brain mass. A case report.

“…After reaching the central nervous system, Schistosoma eggs usually induce a local eosinophilic inflammation resulting from the release of proteolytic enzymes. The resultant inflammation causes damage with granuloma formation and eventually fibrosis and demyelination of the surrounding structures (7). Its manifestations are divided into cerebral Schistosoma, which occurs when S. Japonicum reaches the brain causing encephalitis, which presents with symptoms of headache, seizures, altered mentation, or the spinal schistosomiasis resulting from S. Mansoni (and less commonly S. Hematobium) where it can cause myelitis with symptoms of weakness, back pain, and urine retention (6) Diagnosing neuroschistosomiasis can be challenging as it requires a high index of clinical suspicion.…”