Acute transverse myelitis secondary to schistosomiasis

*Correspondence: [e-mail].

Abstract

Case Presentation: An 8-year-old boy started with severe lower limbs pain, worse on the left, associated with paresthesia that after 15 days progressed to asymmetric paraparesis without sphincter involvement. Her parents denied recent vaccination or infections. On neurological examination, the patient presented asymmetrical paraparesis (MRC grade 3 on the left and grade 4 on the right), bilaterally abolished patellar reflex and superficial anesthesia in the left leg with sensory level in the knee. Magnetic resonance imaging of the thoracic and lumbosacral spine showed expansive lesions in the T12-L1 segments of the thoracic spinal cord and in the conus medullaris, with contrast enhancement. Cerebrospinal fluid evidenced lymphomononuclear pleocytosis (22 leukocytes and 5 eosinophils) and proteinorrachia (90 mg/dL). Blood count showed significant absolute eosinophilia (780/µL). Electromyoneurography had no alteration. After the results, we reviewed clinical history, and the parents reported a trip to the inner of Bahia’s state a year ago that included bathing in lagoons and waterfalls. Therefore, we elaborated the hypothesis of neuroschistosomiasis (NS) and instituted empirical treatment with corticosteroids and praziquantel. The presumptive diagnosis was confirmed with the presence of antibodies against Schistosoma mansoni on cerebrospinal fluid.

Discussion: Acute transverse myelitis is a rare disorder with several etiologies, inflammatory post-infectious is the most common. Pathogens that typically affect the conus medullaris are cytomegalovirus, herpes simplex type II and S. mansoni. Clues for the diagnosis of neuroschistosomiasis are low medullary injury, history of exposure to problable schistosome-infected water and eosinophils in the cerebrospinal fluid, as in our case. It is very important to exclude other causes, especially compressive and non-inflammatory. The definitive diagnosis requires the visualization of eggs or adult worms in the central nervous system; however, cerebrospinal fluid examination with search of antibodies against S. mansoni is an interesting alternative, as we reported here.

Final Comments: We emphasize that even today, schistosomal myelopathy have to be considered because this is one of the most severe forms of schistosomiasis and may lead to permanent neurological damage.

Publication History

Article published online:
12 May 2025