Open AccessShistosomal myelitis and its diagnostic complexity: report of two cases in Alagoas
Author(s) -
Juliana Oliveira de Almeida,
Alice Cavalcante de Almeida Lins,
Bruna Acioly Leão,
Patrícia Nunes,
Nayra Roberta Sales Salvador
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.058
Subject(s) - medicine , myelitis , cauda equina , schistosomiasis , myelopathy , urinary retention , constipation , cauda equina syndrome , context (archaeology) , differential diagnosis , pathology , spinal cord , gastroenterology , surgery , immunology , biology , helminths , paleontology , psychiatry
Context: In Brazil, schistosomal myelitis is the third most common cause of myelopathy. The diagnosis of neuroschistosomiasis is not easy to make. In a study published in 2001, the author proposed a classification for the diagnosis of schistosomal myelorradiculopathy: Proven Diagnosis; Probable Diagnosis and Possible Diagnosis. Case Reports: Case 1, admitted in 2021 with 40 days of paraparesis and ascending paraesthesia, urinary retention and severe low back pain. He had proximal and distal grade 1 paraparesis, eosinophilia at blood count, CSF with hyperproteinorrhachia, normal cellularity and indirect immunofluorescence (IFI) for reactive schistosomiasis, as well as stool parasitology (EPF) and spine MRI with hypersignal in the spinal cord. Case 2, admitted in 2020 with 20 days of constipation and urinary retention followed by paraparesis and ascending paresthesia and sexual impotence. He presented proximal and distal grade 3 paraparesis and CSF with protein-cytological dissociation. Both had abolished deep reflexes and hypoaesthesia with levels in L2 and T10, respectively. As a result of the other exams and MRI with hypersignal of D6 to medullary cone with contrast impregnation and cauda equina roots, despite case 2 having EPF and IFI for schistosomiasis in the CSF negative, for presenting positive epidemiology for schistosomiasis, both were treated with solumedrol for 5 days, praziquantel and oral prednisone, with improvement afterwards. Conclusion: The outcome of schistosomal myelitis is directly related to early diagnosis and treatment. It is necessary to value all clinical, laboratory and epidemiological findings in patients living in an endemic area.