Title of Case(s)
Schistosomal myeloradiculopathy: report of two cases

Background
Schistosomiasis is a public health issue in Brazil, with a broad geographic distribution of cases. Less than 20% of infected individuals present central nervous system involvement. We describe two imported cases of Schistosomal myeloradiculopathy from an endemic area, successfully treated and without sequelae.

Case Presentation Summary
Patient 1: a healthy 11-year old boy presented with pain in right popliteal fossa area, neuropathic gait, and urinary retention. On examination patient presented grade 4 muscle strength in lower limbs and absent Achilles reflex. Spinal cord MRI showed an intramedullary lesion expansion between T10 and conus medullaris, associated with vasogenic edema compatible neuroschistosomiasis. Patient 2: a healthy 6-year-old girl presented with intermittent fever, and weakness and pain in lower limbs. Deep tendon reflexes were absent in the lower limbs, associated with decreased tactile sensory, and sensory loss of pain and temperature. Spinal cord MRI evidenced a nodular lesion in the conus medullaris compatible with neuroschistosomiasis.

Patients had lived in northeast Brazil (an endemic area for Schistosomiasis), where swimming in ponds and rivers was frequent to both children. Serology was positive in blood and CSF in both cases, Kato-Katz stool examination was positive only for patient 1. We used a 5-day course of high-dose corticosteroid followed by praziquantel. Both patients were discharged with low dose oral corticosteroids after clinical improvement. Patient 1 is asymptomatic for >12 months, and steroids were weaned and tapered after six months. Patient 2 is under follow up at our outpatient clinicLearning Points/Discussion
Schistosomal myeloradiculopathy is an important etiology of spinal cord compression in endemic countries. Accurate medical history and extensive epidemiological assessment, neuroimaging, and complementary exams are essential for early diagnosis. Treatment leads to full recovery of symptoms

SCHISTOSOMAL MYELORADICULOPATHY: REPORT OF TWO CASES