Schistosomiasis mansoni-associated neuromyelitis optica: an unprecedent case report

Address for correspondence: Marco A. Lana Peixoto (email: [e-mail]).

Abstract

Despite a significant decline in the incidence of schistosomiasis mansoni (Sm) in Brazil’s once-endemic regions, sporadic cases persist. Myelitis is the most common neurological complication during Sm’s chronic phase, with optic neuritis and chiasmitis also observed as acute parainfectious reactions. We herein report a case of an Sm patient who developed neuromyelitis optica (NMO) syndrome, an association not previously documented. A 34-year-old male patient had an 18-month history of headaches and bitemporal hemianopsia, progressing rapidly to visual acuity (VA) of hand movement in both eyes. The fundoscopy showed mild pallor of the left eye’s temporal rim; the right eye was normal. A brain MRI scan revealed T2/FLAIR and T1-enhanced lesions in the sellar region and optic chiasm thickening. Despite intravenous methylprednisolone treatment, the vision did not improve. A biopsy revealed non-necrotizing granulomatous inflammation with fibrosis, lymphocytes, macrophages, and epithelioid cells, but no Schistosoma eggs. The patient received oral prednisone for four months. Fourteen months later, he developed severe lumbar pain, bladder retention, and pronounced paraparesis with sensory loss in both legs. The VA was of 20/25 in the right eye and of 20/30 in the left eye. A spinal MRI scan showed a central non-enhancing lesion from C6 to T3 and another lesion in the conus medullaris. Cerebrospinal fluid analysis revealed 35 WBC/mm³ with 38% eosinophils, a protein content of 60 mg%, glucose content of 50 mg%, and positive schistosomiasis serology. Treatment with oral prednisone and praziquantel led to partial myelitis recovery, with an EDSS score of 3.0. The association of chiasmitis and longitudinally-extensive transverse myelitis with schistosomiasis has not been previously reported. It highlights the broad concept of NMO syndrome, whose etiopathogenesis extends beyond autoimmune conditions to include various infectious diseases, some of which, such as schistosomiasis, are exclusively found in developing countries.

 

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Artikel online veröffentlicht:
02. Oktober 2024