Cerebral schistosomiasis in a Nigerian patient with end-stage kidney disease

Cerebral schistosomiasis is an uncommon, probably less recognised, but serious neurological complication of Schistosoma infection. Its diagnosis is often delayed due to nonspecific clinical presentations and imaging findings. We report the case of a 29-year-old Nigerian male with end-stage kidney disease on dialysis who presented with headaches, fever, generalised seizures, and left-side emiplegia. His brain MRI revealed a contrast-enhancing right frontotemporal mass lesion with surrounding oedema and midline shift, initially suggestive of a cerebral abscess. Empirical treatment with antibiotics, steroids, and anticonvulsants provided partial relief. Surgical intervention via craniotomy and partial resection revealed a vascular, greyish-yellow mass. Histopathology confirmed Schistosoma eggs surrounded by granulomatous inflammation, establishing a diagnosis of cerebral schistosomiasis. The patient was treated with praziquantel and dexamethasone, and levetiracetam, leading to complete resolution of neurological symptoms and seizure control. Follow-up imaging showed significant lesion regression. This case underscores the diagnostic challenge of cerebral schistosomiasis, particularly in immunocompromised patients. Despite living in an endemic area, the absence of recent freshwater exposure and the absence of suspicious clinical history delayed diagnosis. Radiological features mimicked neoplastic or infectious lesions, emphasizing the need for histological confirmation. Cerebral schistosomiasis should be considered in patients with space-occupying brain lesions in endemic regions. Early recognition and targeted therapy can yield favourable outcomes.