Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

Abstract

Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here. Key-words:Brain tumor. Neuroschistosomiasis. Myeloradiculopathy. RESUMOTem sido descrita, raramente, na esquistossomose mansônica, a ocorrência simultânea de tumor cerebral e mielorradiculopatia. Relatamos aqui o caso de um homem de 38 anos que desenvolveu convulsões, durante viagem a Porto Rico, e um tumor cerebral foi diagnosticado à ressonância magnética: a biópsia do cérebro revelou o diagnóstico de esquistossomose. Ele foi transferido para hospital na América do Norte e durante a hospitalização desenvolveu súbita paraplegia. O diagnóstico de mielorradiculopatia foi confirmado na ocasião. Ele recebeu praziquantel e esteróides. O tumor cerebral desapareceu, mas o paciente permaneceu com paraplegia, disfunção urinária e fecal. Ele tem sido acompanhado no Brasil no último ano e o seu estado clínico, os métodos de imagem e os exames de laboratório são apresentados aqui. Palavras-chaves:Tumor cerebral. Neuroesquistossomose. Mielorradiculopatia. Neurological involvement is associated with infection by the three main species of Schistosoma (Schistosoma mansoni, Schistosoma japonicum and Schistosoma haematobium) 1 2 9 11 13 21 . Although myeloradiculopathy is the most common neurological complication of Schistosoma mansoni infection, the prevalence of cerebral and spinal cord schistosomiasis is unknown. Neuroschistosomiasis is probably underdiagnosed, underestimated and underreported 8 12 14 .Severe neurological involvement has been described during the early post-infective stage in non-immune patients 10 15 . Acute encephalitis and cerebral vasculitis have been reported during primary infection with Schistosoma mansoni 9 28 . Asymptomatic neuroschistosomiasis appears to be more frequent in association with the more severe chronic forms of Schistosoma mansoni. A Brazilian autopsy case series revealed scattered ova of Schistosoma mansoni in 25% of the brains of patients (without neurological deficit) who died due to hepatosplenic schistosomiasis 24 .Schistosoma mansoni can also cause a brain tumor-like syndrome due to slowly expanding cerebral and cerebellar lesions 4 6 15 18 23 24 26 27 .Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection 11 13 1...

Brain schistosomiasis in mice experimentally infected with Schistosoma mansoni

“…Recently, as we were studying human neuroschistosomiasis, we began to suspect that the manifestations in mice may be signs of brain involvement 12,13 . Surprisingly, Schistosoma mansoni eggs and granulomas were identifi ed in the CNS of symptomatic animals.…”

Neuroschistosomiasis

“…Patients may present with acute encephalitis or myelopathy or both during the acute phase of the disease after systemic manifestation or during the early stages of chronic disease [7,13,[26][27][28]. Cerebral schistosomiasis involvement occurs more frequently in S. japonicum infections while myelopathy is more common in S. mansoni and S. haematobium infections [26][27][28].…”

Neuroschistosomiasis mansoni

“…Brain magnetic resonance (MR) imaging showed a left frontalparietal lesion with the "arborized" appearance firstly described by Sanelli et al 67 Brain biopsy confirmed the schistosomal infection, and the patient was treated with praziquantel and dexamethasone. Lambertucci et al 68 reported the case of a 38-year-old American citizen who lived in Brazil and developed seizures during a trip to Puerto Rico. Brain MR imaging showed a large hyperintense tumoral lesion in the right frontalparietal lobe, and brain biopsy yielded the diagnosis of CS.…”

“…In addition, spinal atrophy can be observed in patients having a longer disease course. 68,73,79 Although sensitive, these abnormalities are not specific for SMR.…”