Diagnostic Challenges in Cerebral Schistosomiasis: A Case of Schistosoma japonicum Misinterpretation

BACKGROUND Schistosomiasis is a zoonotic parasitic disease affecting over 240 million people in 77 countries. Cerebral schistosomiasis (CSM) occurs when parasitic eggs form granulomas within the central nervous system. This condition, although generally considered rare, is one of the most severe and under-recognized clinical manifestations. The scarcity of systematic studies on its clinical characteristics often leads to CSM being misdiagnosed as other brain lesions. A definitive diagnosis often requires invasive histopathological examination after craniotomy, underscoring the diagnostic challenges. CASE REPORT A 28-year-old man presented with persistent headaches and was initially misdiagnosed with an intracranial space-occupying lesion. Following surgical intervention, histopathological examination revealed Schistosoma eggs in the brain tissue. Serological tests confirmed the presence of Schistosoma japonicum antibodies. The patient received anthelmintic treatment with praziquantel, combined with oral prednisone for anti-inflammatory purposes and intravenous 20% mannitol. He recovered and was discharged after his condition stabilized. One-year follow-up showed no discomfort, and re-examination for Schistosoma japonicum antibodies yielded negative results. CONCLUSIONS This case highlights the diagnostic complexity of CSM and its potential to be misdiagnosed as an intracranial tumor. It emphasizes that for unexplained central nervous system lesions, especially in patients with a relevant travel or exposure history, a comprehensive evaluation is essential. Integrating epidemiological data, serological testing, and advanced imaging can provide crucial diagnostic clues. This approach can help establish an accurate diagnosis, guide appropriate anthelmintic therapy, and potentially reduce the need for risky and unnecessary neurosurgical interventions, thereby improving clinical outcomes in both endemic and non-endemic settings.