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Título

LONGITUDINAL EXTENSIVE TRANSVERSE MYELITIS CAUSED BY SCHISTOSOMIASIS: A CASE REPORT

RESUMO

CASE PRESENTATION: A previously healthy 47-year-old man presented with a history of diarrhea associated with low back pain since January 2022. He evolved in one month with bilateral leg paresthesia and later spastic paraparesis. He also presented urinary urgency and incontinence, intestinal constipation and erectile dysfunction. In the neurological examination there were hyperreflexia in the upper and lower limbs (more overresponsive in the inferior limbs), bilaterally positive Hoffman and Babinski responses, bilateral spinal automatism, and bilateral paretic gait. In addition, there was decreased superficial sensation up to the T7 level, but no alterations in deep sensation. The MRI of the spine revealed an extensive lesion, more evident in the mid-segment of T1-T7, and affecting mainly the central spinal cord denoting probable myelitis. Active infection by Schistosoma mansoni was evidenced in a kato-katz stool parasitological examination. The CSF analysis showed increased cellularity including eosinophils and protein level with positive anti-Schistosoma serology. ANA, HIV/HTLV serology, VDRL, rheumatoid factor, anti RO, anti LA, and vitamin B12 level were unremarkable, and anti-aquaporin-4 was negative. He received intravenous therapy with 1g methylprednisolone for 5 days and oral praziquantel. He progressively improved and regained gait after treatment. DISCUSSION: We present a case of neuroschistosomiasis as the cause of spastic paraparesis with superficial sensory loss up to thoracic level, and sphincter dysautonomic syndrome. The spinal cord lesion was not only high, but also longitudinally extensive, which is uncommon. Myeloradiculitis is the most common extraintestinal manifestation of schistosomiasis. It is caused by the presence of the parasite egg or the adult worms that migrate through the venous plexus of Batson to the spinal cord and induce a focal granulomatous reaction. Due to its anatomy, the most frequent locations are the lower thoracic and lumbar regions of the spinal cord, unlike the presented case. FINAL COMMENTS: In the context of thoracic, longitudinal extensive spinal cord lesions, it is important that schistosomal myeloradiculitis should be included in the differential diagnosis, especially in endemic areas.

Palavras Chave

Transverse Myelitis, Schistosomiasis, Case report