Neuroschistosomiasis Mimicking Spinal Tuberculosis: A Case Report.

Abstract

Schistosomiasis is a chronic parasitic disease acquired through freshwater exposure, in which cercariae penetrate the skin and mature into adult worms. Disease manifestations largely result from granulomatous inflammation and fibrosis surrounding retained eggs. A 65-year-old widow presented with six months of lower back pain, weight loss, paraplegia (power 1/5), sphincter dysfunction, a T12 sensory level, and T9-T10 gibbus. She had received empirical antitubercular therapy for two months without improvement. Thoracolumbar MRI demonstrated vertebral and disc collapse at T10-T11 and L1-L2, with adjacent paravertebral abscesses and cord compression. Surgical biopsies revealed numerous calcified Schistosoma haematobium eggs with terminal spines, surrounded by granulomas containing epithelioid histiocytes, foreign-body giant cells, lymphocytes, and eosinophils. She received weekly praziquantel (1,200 mg) and tapered prednisolone. Motor power improved to 2/5, although urinary and faecal incontinence persisted. Neuroschistosomiasis should be considered in endemic regions, particularly when presumed spinal tuberculosis fails to respond to treatment. Definitive diagnosis requires careful clinicoradiological and histopathological evaluation.