Schistosoma mansoni of the conus medularis: case report

A six year old girl was admitted to the Kenyatta National Hospital paediatric unit with history of headaches, fever, neck stiffness and paraesthesias of the lower limbs. She was empirically commenced on antimeningitic treatment. Her neurological state deteriorated over a period of two months to paraparesis and paraplegia of the lower limbs with urinary and stool incontinence. A neurology review revealed a sensory level at T10 with power grade 2 in the lower limbs. A myelogram revealed a block of contrast at T12. An impression of cord compression by an intraspinal tumour was made. Laminectomy and posterior midline myelotomy was performed. At operation a greyish-white intramedullary mass lesion was found. Histology revealed a schistosoma mansoni ovum surrounded by granulomatous tissue with giant cells and polymorphoneuclear leucocytes. The child was commenced on paziquantel 1000 mg and dexamethasone 24 mg per day in divided doses. There was marked neurological improvement and the patient went home one month later. She was able to walk without support and was continent of urine and stool at the time of discharge.