Schistosomal myelitis: findings at MR imaging

Abstract

Schistosomal spinal cord involvement is a rare complication of infection by Schistosoma mansoni. This work reports the MR imaging findings in a patient with schistosomal myelitis involving the lower spinal cord and conus medullaris. MR imaging showed a focal mass with a slightly nodular surface and which had peripheral enhancement after contrast administration. The MR appearance of this complication of schistosomal infection is important to recognize so that early medical therapy can be started in an attempt to maximize neurologic recovery.

Introduction

Schistosomal infection typically occurs in a few endemic regions: east Asia (particularly China, Japan and the Phillipines), South America and the Caribbean islands, Arabia and parts of Africa. However, the disease is not rare in the United States. In 1977, the number of cases in continental North America was estimated at 400 000 [1]. This number may be even higher at present, due to an increase in foreign travel and immigration from endemic regions. The radiographic features of complications of schistosomal infection are, therefore, important for radiologists in non-endemic regions to recognize. We present the MR imaging findings of a patient with schistosomal myelitis, a rare complication of schistosomiasis in which the clinical presentation can be mimicked by a wide spectrum of diseases 2, 3. Early treatment with the antiparasitic agent Praziquantal is important in limiting neurologic disability and improving the chances of recovery [4]. The availability of an effective treatment emphasizes the need for recognition of the imaging findings and for early diagnosis.