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.
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.
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.
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
a
b
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.