Abstract Details

Title Spinal Schistosomiasis masquerading as an Intramedullary Astrocytoma

Topic Infectious Disease

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-034

Objective To describe a case of intramedullary schistosomiasis mimicking infiltrative tumor.

Background Neuroschistosomiasis often occurs without signs of systemic infection and can present at any time throughout the parasitic lifecycle. Symptoms vary depending on the species involved and can affect the brain (encephalopathy, seizures, focal weakness, ataxia, with multifocal contrast enhancing lesions) or spinal cord (inflammatory myelopathy with T2 hyperintensity and expansion of the cauda equina and conus medullaris). Granulomatous inflammation can affect the cord, cauda equina, and other spinal nerves and cause paraparesis, bowel/bladder/sexual dysfunction, and radicular symptoms. Given the parasite’s propensity for the nervous system without causing systemic symptoms, and the worms’ absence in the US, schistosomiasis is not readily considered by many practitioners.

Design/Methods Clinical case, diagnostics, imaging, pathology and literature review.

Results

A 22-year-old male from Yemen presented with low back pain, numbness and paresthesias of his feet, intermittent urinary retention and bowel incontinence for 8 months. Exam showed sensory deficits in an L5-S1 distribution bilaterally. Basic labs were unremarkable. Nonenhanced MRI lumbar spine was normal. EMG demonstrated bilateral L5-S1 radiculopathies. Repeat MRI lumbar spine with contrast showed an expansile infiltrative T2 hyperintensity extending from the caudal thoracic cord to conus medullaris (T9-L1) and nodular heterogeneous enhancement at T11 and T12.

Given concern for infiltrative astrocytoma, patient underwent surgical excision. Biopsy revealed a densely gliotic thoracic cord with a granulomatous inflammatory reaction to Schistosoma mansoni. Serum schistosoma IgG antibody was positive and stool O&P demonstrated blastocystis hominis cysts. He was treated with dexamethasone and praziquantel with improvement of symptoms.

Conclusions Spinal schistosomiasis is an important diagnostic consideration in patients with myelopathic or radiculopathic symptoms, especially in those from or with recent travel to endemic areas. A high index of suspicion is necessary to avoid diagnostic delays and invasive procedures.

Authors/Disclosures
Alexandra Kvernland, MD (NYU Department of Neurology) PRESENTER	Dr. Kvernland has nothing to disclose.
Ericka S. Wong, MD (Jefferson Health)	Dr. Wong has nothing to disclose.
Arielle M. Kurzweil, MD, FAAN (NYU)	Dr. Kurzweil has nothing to disclose.

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