Background

Although acute longitudinally extensive transverse

myelitis (LETM) is a key diagnostic component of

neuromyelitis optica (NMO) it may also occur in other

conditions such as multiple sclerosis, sarcoidosis and

infectious diseases. Schistosomiasis is a human trematode

infection affecting at least 200 million people in endemic

areas in Africa, South America, and Asia. Involvement of

the spinal cord may cause severe lumbar pain followed by

paraparesis associated with sensation and sphincter

disturbances. Such a clinical picture is frequently seen as

the first index event in NMO. Finding of a tumefactive

longitudinally extensive lesion on spinal MRI may further

confound the diagnosis. We report on three patients with

schistosomal myelitis and LETM.

Cases

Patients were a 21-YO black female, a 23-YO indian male,

and a 70-YO mulattoe male. All had lived for years in

endemic areas for schistosomiasis and had had contact with

contaminated water. The clinical presentation of the disease

was similar in all of them, and was characterized by lumbar

pain, followed by paraparesis, dysesthesia in the lower

limbs, and sphincter disturbances. Patient 3 was the only

one who had a previous diagnosis of intestinal and hepatic

schistosomiasis. All patients had positive stool examination

and rectal biopsy for ova of Schistosoma mansoni. Spinal

MRI disclosed in all three patients tumefactive T2-

weighted isointense or hyperintense, T1-weighted

hypointense gadolinium-enhanced

longitudinally extensive lesions. Lesions extended from

T4 to the conus medullaris in Patient 1; from T1 to T12

in Patient 2; and from T7 to T11 in Patient 3. Brain

MRI was unrevealing. Patients 1 and 2 did not respond

to treatment and remained wheelchair-bound, whereas

Patient 3 had a full recovery.

Figure. a. Case 2. Tumefactive T2-weighted lesion extending through the thoracic spinal cord. b. Case 3. T2-weighted hyperintense lesion extending from T7 to T11.

Conclusion

In endemic areas schistosomal myelitis should be included in the differential diagnosis of LETM. Neurologic outcome may depend on immune response of the host but prompt diagnosis and treatment may favor recovery.

Longitudinally Extensive Transverse Myelitis in Schistosomiasis

Juliana M.S.S. Amaral, Igor Ornelas, Natália C. Talim, Lívia E.C. Talim, Rodrigo Kleinpaul, Marcia Prates, Diogo C. Carvalho, Tauana S. Tironi, Izabela Duarte, Anderson Silva, Gisele O Lima, Carolina R. Araujo, Cristiane F. Rocha,

Marco A. Lana-Peixoto.CIEM MS Research Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil.

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