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Radiol Case Rep. 2021 Dec 09;17(3):462-466. doi: 10.1016/j.radcr.2021.11.018. eCollection 2022 Mar.

Medullary neuroschistosomiasis in a pediatric patient: a case report.

Radiology case reports

Kumeshnie Kollapen, Farhana Ebrahim Suleman, Izelle Smuts, Lebohang Siwela

Affiliations

  1. Department of Radiology, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, c/o Steve Biko and Malan Street, Private Bag X169, Pretoria, 0001, South Africa.
  2. Department of Radiology, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Private Bag X20, Pretoria, 0001, South Africa.

PMID: 34950274 PMCID: PMC8671095 DOI: 10.1016/j.radcr.2021.11.018

Abstract

A pediatric patient with neurological deficit was examined using magnetic resonance imaging (MRI]. The images revealed abnormal signal intensity and enhancement of the spinal cord, indicating myelopathy. Identifying the cause of the myelopathy required a differential diagnosis. Images from MRI included a pre-contrast T1 weighted sagittal sequence, which revealed expansion of the distal lumbar spinal cord and conus medullaris from T10-L1. The T2 weighted sagittal sequence revealed patchy areas of hyperintense signal. We did not notice any chronic hemorrhagic products or cysts. Within the field of view, we saw multifocal areas of bladder wall thickening. Sagittal and axial T1 weighted post gadolinium images demonstrated mixed linear and nodular patchy enhancement of the conus medullaris predominantly anteriorly and along the anterior surface of the meninges. On the 18 day of hospitalization, a spinal biopsy revealed the presence of granuloma with non-viable bilharzia ova, and schistosomiasis of the spinal cord was diagnosed. Although uncommon, when it does occur, schistosomiasis has significant implications. Using MRI, the medical team noticed abnormal features that called for a biopsy, and were thus able to differentiate between medullary schistosomiasis and other infective/inflammatory conditions. A prompt diagnosis is vital for initiating early treatment, and avoiding complications and invasive surgery.

© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

Keywords: MRI; Schistosomiasis; Spinal cord

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