# Spinal cord Schistosomiasis in a 26-year-old male patient with progressive lower limb weakness and sensory loss: A case report

## TL;DR

A 26-year-old man with spinal cord schistosomiasis showed symptoms similar to a tumor, but recovered after treatment with praziquantel and corticosteroids.

## Contribution

This case report highlights the diagnostic challenge of spinal schistosomiasis and the effectiveness of combined therapy for recovery.

## Key findings

- Spinal cord schistosomiasis can mimic intramedullary tumors on MRI, leading to diagnostic uncertainty.
- Combined praziquantel and corticosteroid therapy resulted in significant neurological recovery in this patient.

## Abstract

•Spinal cord schistosomiasis can closely mimic intramedullary spinal tumors.•Epidemiologic exposure is key to early diagnosis of schistosomal myelopathy.•Magnetic resonance imaging findings are suggestive but not diagnostic of spinal schistosomiasis.•Combined praziquantel and corticosteroid therapy enables neurologic recovery.•Histopathologic examination remains the gold standard for definitive diagnosis, particularly, when imaging findings mimic intramedullary tumors or other inflammatory myelopathies.

Spinal cord schistosomiasis can closely mimic intramedullary spinal tumors.

Epidemiologic exposure is key to early diagnosis of schistosomal myelopathy.

Magnetic resonance imaging findings are suggestive but not diagnostic of spinal schistosomiasis.

Combined praziquantel and corticosteroid therapy enables neurologic recovery.

Histopathologic examination remains the gold standard for definitive diagnosis, particularly, when imaging findings mimic intramedullary tumors or other inflammatory myelopathies.

Spinal cord schistosomiasis is a rare but potentially devastating manifestation of Schistosoma infection, resulting from an inflammatory granulomatous response to parasite eggs trapped in the spinal cord. It poses a significant diagnostic challenge, often mimicking intramedullary tumors. We report the case of a 26-year-old male patient residing near Lake Victoria who presented with acute, progressive paraplegia, sensory loss, and autonomic dysfunction. Magnetic resonance imaging revealed a focal enhancing intramedullary lesion at the T12-L1 level. Given the diagnostic uncertainty, a decompressive biopsy was performed, which confirmed the presence of Schistosoma mansoni ova within a granulomatous infiltrate. The patient was treated with a combination of praziquantel and systemic corticosteroids, resulting in significant neurologic recovery. This case highlights the critical importance of maintaining a high index of suspicion for schistosomiasis in patients presenting with myelopathy and relevant epidemiologic exposure. Prompt diagnosis, aided by histopathology or serology, and early initiation of dual medical therapy are essential to prevent permanent neurologic sequelae.