Conus medullaris schistosomiasis, presenting as acute conus-cauda equina syndrome in a pediatric patient: a case report.
This case report describes a 7-year-old girl with an intramedullary conus lesion mimicking a tumor that was resected and identified histologically as Schistosoma haematobium granulomatous disease, followed by praziquantel, steroids, pain resolution, and partial-to-substantial motor recovery.
Open original publication →What the AI sees
This case report describes a 7-year-old girl with an intramedullary conus lesion mimicking a tumor that was resected and identified histologically as Schistosoma haematobium granulomatous disease, followed by praziquantel, steroids, pain resolution, and partial-to-substantial motor recovery.
Research significance
The reported case supports considering spinal schistosomiasis in the differential diagnosis of pediatric conus masses; it is reasonable—but unproven from this single multimodally treated case—to hypothesize that earlier recognition and targeted antiparasitic therapy could improve neurologic outcomes or alter the need for surgery in selected patients.
Source abstract
BACKGROUND: Conus medullaris intramedullary schistosomiasis is a rare disease, and may present acutely with serious neurological consequences. In its early stages, making a prompt diagnosis, and instituting appropriate treatment results in a good outcome. We share our experience of the diagnostic challenge, surgical treatment and outcome of care of this rare disease entity. CASE DESCRIPTION: A 7-year-old female patient, of Mada ethnicity, presented with 4 days history of bi-sphincteric dysfunction, severe low back pain, and paraparesis. Examination of the patient revealed a bilateral muscle power of 4/5 at L2-3, and 0/5 at L4-S1. Thoracic spine magnetic resonance imaging (MRI) showed a fusiform distension of the conus medullaris, with an intradural, intramedullary (ID, IM) mass; isointense on T1, and hyperintense on T2. She had T12-L1 laminectomy with complete resection of the mass. Histopathological evaluation revealed a granulomatous lesion with Schistosoma haematobium ova. Patient subsequently had praziquantel and steroid therapy postoperatively, with complete resolution of back pain, and regain of full muscle power of 5/5 at L2-L4, and 3/5 at L5-S1, in both limbs. CONCLUSION: This case demonstrates the need for a high index of suspicion in considering Schistosomiasis as a differential diagnosis of ID, IM tumor of the conus medullaris in pediatric patients. This will result in a prompt diagnosis, and the early institution of appropriate therapy which is often associated with good outcome.