Atypical presentation of spinal schistosomiasis with involvement of the cervicothoracic spine.

Abstract

A 25-year-old patient, born in Eritrea who had lived for 7 years in Nigeria before he arrived in France 1 year ago, was referred for subacute and progressive tetraparesis evolving over 2 months. Examination revealed tetraparesis, impairment of sensory function below the C6 level and tetrapyramidal syndrome. Spine MRI showed increased T2 intensity at the C6 to T11 spinal cord levels consistent with a longitudinally extensive transverse myelitis. After gadolinium administration, a diffuse, nodular, and heterogeneous pattern of contrast enhancement was seen. Cerebrospinal fluid disclosed pleocytosis with 14% eosinophils, associated with an elevated protein level. Exhaustive analysis ruled out bacterial, viral, mycobacterial, or fungal infection. The diagnosis of spinal schistosomiasis was confirmed by detection of S. mansoni DNA in blood and cerebrospinal fluid by polymerase chain reaction (PCR). Treatment with praziquantel was initiated. The clinical course was favourable and follow-up spine MRI at 6 months disclosed a dramatic reduction in the T2 signal abnormality without contrast enhancement. Our case is notable because of the cervicothoracic involvement and because a post-therapeutic MRI was available, confirming the patient's favourable evolution.