Schistosomal myeloradiculopathy associated with hepatitis B virus infection: a case report

Abstract

Schistosomiasis affects over 200 million people worldwide. The involvement of the central nervous system (CNS) is rare but when it occurs, the spinal cord damage is the most common and severe form. The reported case is a 19-years-old patient with asymmetric progressive paraparesis, areflexia in the lower limbs, urinary incontinence and back pain. He used to swim in ponds of endemic area for S. mansoni. Cerebrospinal fluid presented pleocytosis with 53 cells per mm3 where 3% eosinophils, 87% lympho-cytes, 10% monocytes, Glucose 67mg/dL protein and 176mg/dL. Spinal MRI showed extensive damage from T1 to L2 in T2-weighted acquisition and heterogeneous contrast uptake in lumbosacral cord, suggesting active inflammation in the latter region. It also presented positive stools for Schistosoma mansoni and positive serology for hepatitis B virus (HBV) in its chronic form. It´s emphasized in this paper that the myeloradiculopathy by schistosomiasis (MRE) has consistent clinical diagnostic criteria and early diagnosis and treatment is of paramount importance to avoid neurological and disabling sequelae.