Long-Lasting Latent Neuroschistosomiasis in a Nonendemic Country: A Case Report

Neuroschistosomiasis is an uncommon yet serious cause of myelopathy. Schistosoma mansoni infection triggers a granulomatous immune response by the human host, resulting in many clinical presentations, depending on the size of the granuloma and its location. The parasitic infection can remain silent for a long period, and this diagnosis should be considered if there is a history of previous exposure in endemic regions. Prompt diagnosis and treatment are crucial for a favorable outcome, minimizing the risk of permanent neurological disability. A case of medullary neuroschistosomiasis is presented, many years after exposure, in a patient who presented with low back pain, rapidly progressing to paraparesis with significant gait impairment. Magnetic resonance imaging findings revealed extensive medullary involvement from the conus all the way to the cervical spine level. After ruling out other causes of myelopathy and considering previous history, total anti-Schistosoma antibodies were tested and detected, confirming the diagnosis. Steroids and schistosomicides were started, with remarkable clinical and imagiological improvement. The patient regained normal muscle strength, gait, and functional independence in the following six months.