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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682

Rev. Soc. Bras. Med. Trop. vol.46 no.2 Uberaba Mar./Apr. 2013

http://dx.doi.org/10.1590/0037-8682-0038-2013 

Images In Infectious Diseases

Pseudo-tumoral spinal cord schistosomiasis

Thiago Cardoso ValeI 

Sílvio Roberto de Sousa-PereiraII 

José Roberto LambertucciII 

IDivisão de Neurologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG

IIDivisão de Doenças Infecciosas, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG


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

1. Lambertucci JR. Acute schistosomiasis mansoni: revisited and reconsidered. Mem Inst Oswaldo Cruz 2010; 105:422-435. [ Links ]

2. Lambertucci 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. [ Links ]

3. Lambertucci JR, Silva LC, Amaral RS. Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy. Rev Soc Bras Med Trop 2007; 40:574-581. [ Links ]

Received: February 18, 2013; Accepted: February 19, 2013

Address to: Dr. José Roberto Lambertucci. Av. Professor Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brasil. Phone: 55 31 3409-9820; 55 31 3409-9821. e-mail: lamber@uai.com.br

FINANCIAL SUPPORTThe work has been partially supported by CNPq/Brazil.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.