A 5-year-old girl presented with a seven-day history of lower-limb pain and paraplegia, urinary and fecal retention. Neurological examination revealed flaccid paraparesis, lack of patellar and achilles-tendon bilateral reflexes, and sphincter impairment. She had contact with natural waters in an endemic area for schistosomiasis and Schistosoma mansoni eggs were found in her stools. Cerebrospinal fluid analysis showed 136 cells/dL (98% neutrophils and 2% monocytes), 128mg/dl of proteins and normal glucose level. Spinal cord magnetic resonance (MR - coronal section) revealed a tumoral lesion with hyperintense signal and contrast enhancement from T10 to L1 levels (Figure A - conus medullaris). The patient was treated with praziquantel (50mg/kg, body weight, single dose) and intravenous steroids (methylprednisolone, 15mg/kg/day, for 5 days). Prednisone (40mg/day) was given afterwards for 4 months with complete recovery. MR repeated 6 months after dismissal from the hospital showed a normal spinal cord (Figure B - Sagital MR before and 6 months after treatment). She had no complaints and looked healthy (Figure C). Children with recent infection and severe myeloradiculopathy seem to respond better to treatment than older people.
REFERENCES
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1Lambertucci JR. Acute schistosomiasis mansoni: revisited and reconsidered. Mem Inst Oswaldo Cruz 2010; 105:422-435.
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2Lambertucci JR, Serufo JC, Gerspacher-Lara R, Rayes AAM, Teixeira R, Nobre V, et al. Schistosoma mansoni: assessment of morbidity before and after control. Acta Trop 2000; 77:101-109.
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3Lambertucci JR, Silva LC, Amaral RS. Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy. Rev Soc Bras Med Trop 2007; 40:574-581.
Publication Dates
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Publication in this collection
Mar-Apr 2013
History
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Received
18 Feb 2013 -
Accepted
19 Feb 2013
