Schistosomal myeloradiculopathy-an underdiagnosed disease: case report
- International Journal of Radiology & Radiation Therapy
Daniela Mello Tonolli, Danielle Navarro Sato, Maria Fernanda Melega Mingossi, Leticia Lambert, Lorraine Lorene Felix Cardoso
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The aim of this study is to relate the condition of paraplegia due to schistosomal myeloradiculopathy with an initial diagnosis of polyradiculoneuropathy in a patient from an endemic area.This disease is the most severe and disabling ectopic form of Schistosoma mansoni infection, being underreported, of unknown prevalence and underestimated morbidity. Its recognition and the early institution of treatment play a fundamental role in the prevention of severe and irreversible injuries, as well as in the recovery of affected people, usually young people in full production phase. The diagnosis of schistosomal myeloradiculopathy is based on epidemiology, clinical findings regarding neurological conditions and evidence of Schistosome mansoni in laboratory tests such as serological techniques or stool parasitological examination and other causes for the condition should be excluded. In the case described, the patient reported swimming in a lagoon in Sergipe, an endemic zone, which makes the epidemiology speak strongly in favor of the diagnostic hypothesis. The clinical presentation presented by the patient is very similar to that of this myeloradiculopathy and that Schistosoma eggs were found in the feces, and the serology and cerebrospinal fluid analysis (CSF) serology were positive for this parasite. It is noteworthy that magnetic resonance imaging is a very sensitive propaedeutic method for the evaluation of schistosomal myeloradiculopathy, although the diagnosed alterations are not specific for this disease. The changes observed on magnetic resonance imaging (MRI) regress in parallel with the clinical improvement of the patient after treatment with schistosomicides and corticosteroids, as can be observed in this case. Finally, the treatment was done with praziquantel, ivermectin and corticosteroid therapy in association with motor physiotherapy. The patient presented clinical improvement, but maintained mild motor deficit.
schistosome mansoni, magnetic resonance imaging, neuroschistosomiasis, paraplegia, polyradiculoneuropathy