Spinal schistosomiasis: Differential diagnosis for acute paraparesis in a US resident

Tapan N. Joshi, Michael K. Yamazaki, Holly Zhao, Daniel Becker

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Spinal schistosomiasis is a severe presentation of Schistosoma mansoni infection, which is endemic in South America, the Middle East, and sub-Saharan Africa. With increasing international travel, a disease can spread from an endemic area to another part of the world easily. Objective: To present a case of a US resident who developed acute paraparesis due to spinal schistosomiasis after traveling to sub-Saharan Africa. Participant: A 45-year-old woman presented with abdominal pain radiating into the bilateral lower extremities. She was diagnosed with a pelvic mass and underwent an urgent hysterectomy with right salpingo-oopherectomy. Postoperatively, she developed progressive weakness with worsening pain in her bilateral lower extremities and neurogenic bladder. Magnetic resonance imaging showed an abnormal T2 hyperintense signal in the entire spinal cord below the T3 level with abnormal contrast enhancement from T9 through the conus medullaris. Spinal fluid analysis showed lymphocytic pleocytosis and elevated protein. The patient was diagnosed with transverse myelitis. Subsequently, a detailed history revealed a visit to Ethiopia 2 years earlier. Tests for S mansoni were positive. After treatment with praziquantel and prednisone, her neurologic function began to improve. Conclusions: An increasing incidence of international travel is increasing the likelihood of US physicians' encountering this treatable condition. Travelers with spinal schistosomiasis may not have symptoms of systemic infection. Therefore, it is important to include spinal schistosomiasis in the differential diagnosis of acute inflammatory myelopathy, particularly with a history of travel to endemic areas.

Original languageEnglish (US)
Pages (from-to)256-260
Number of pages5
JournalJournal of Spinal Cord Medicine
Volume33
Issue number3
DOIs
StatePublished - Jan 1 2010

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Paraparesis
Schistosomiasis
Differential Diagnosis
Africa South of the Sahara
Lower Extremity
Spinal Cord
Transverse Myelitis
Myelitis
Praziquantel
Schistosomiasis mansoni
Neurogenic Urinary Bladder
Ethiopia
Middle East
South America
Leukocytosis
Prednisone
Hysterectomy
Abdominal Pain
Nervous System
History

Keywords

  • Myelopathy
  • Myeloradiculopathy
  • Paraparesis
  • Parasites, helminthic
  • Praziquantel
  • Schistosoma
  • Schistosoma mansoni
  • Schistosomiasis, spinal

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Spinal schistosomiasis : Differential diagnosis for acute paraparesis in a US resident. / Joshi, Tapan N.; Yamazaki, Michael K.; Zhao, Holly; Becker, Daniel.

In: Journal of Spinal Cord Medicine, Vol. 33, No. 3, 01.01.2010, p. 256-260.

Research output: Contribution to journalArticle

Joshi, Tapan N. ; Yamazaki, Michael K. ; Zhao, Holly ; Becker, Daniel. / Spinal schistosomiasis : Differential diagnosis for acute paraparesis in a US resident. In: Journal of Spinal Cord Medicine. 2010 ; Vol. 33, No. 3. pp. 256-260.
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