Conus medullaris syndrome caused by spinal cord schistosomiasis: case report

Abstract

Background: Neuroschistosomiasis is a rare but severe complication of schistosomiasis that is often underdiagnosed and can affect both the brain and the spinal cord. CNS involvement occurs during hepato-intestinal or intestinal phase of the disease, when the Schistosoma eggs or adult worms reach the vertebral venous plexuses via Batson plexuses. Objective: To report a case of a patient with conus medullaris syndrome caused by spinal cord schistosomiasis whose symptoms had great improvement after undergoing treatment with praziquantel and prednisone. Case report: A 45-year-old woman, from Bahia, Brazil, with no significant medical history, presented with intense pain in her legs from knees below, associated with progressive loss of strength, tingling and dysesthesias in both lower limbs, causing gait impairment followed by urinary retention. At physical examination, grade III paraparesis in proximal limbs and grade IV in distal limbs and unsteady dysbasic gait were observed, no meningeal signs were found. MRI study revealed hyperintense signal in medulla at the level of T12-L1 to conus medullaris in T2 sequences, mainly on central portions and medulla, also slight impregnation with gadolinium showing dotted pattern was observed, suggestive findings of inflammatory myelitis. KatoKatz test was performed evidencing Schistosoma eggs. After diagnosis, patient was treated with prednisone and praziquantel for 5 weeks. At the end the of treatment, she has showed progressive improvement of her symptoms. In our last evaluation, the patient showed a great recovery of movement and strength, now grade IV in proximal limbs and grade V in distal limbs as well as a steadier gait. Urinary retention is still present, and she still needs intermittent catheterization for the time being Conclusion: Neuroschistosomiasis, when symptomatic, is a severe disorder in which can cause significant incapacity and morbidity. It is an underdiagnosed disorder but has been increasingly reported in populations in endemic areas and in tourists. Prognosis depends largely on early diagnosis and treatment.