Spinal schistosomiasis: differential diagnosis for acute paraparesis in a U.S. resident.
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.


METHODS
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.
Joshi
Tapan N
TN
International Center for Spinal Cord Injury, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA. joshi@kennedykrieger.org
Yamazaki
Michael K
MK
Zhao
Holly
H
Becker
Daniel
D
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D020335:Paraparesis / Q000175:diagnosis* / Q000209:etiology*; D012552:Schistosomiasis / Q000150:complications* / Q000175:diagnosis*; D013116:Spinal Cord / Q000473:pathology*; D014481:United States