Conus medullaris schistosomiasis, presenting as acute conus-cauda equina syndrome in a pediatric patient: a case...

Conus medullaris intramedullary schistosomiasis is a rare disease, and may present acutely with serious neurological consequences. In its early stages, making a prompt diagnosis, and instituting appropriate treatment results in a good outcome. We share our experience of the diagnostic challenge, surgical treatment and outcome of care of this rare disease entity.

A 7-year-old female patient, of Mada ethnicity, presented with 4 days history of bi-sphincteric dysfunction, severe low back pain, and paraparesis. Examination of the patient revealed a bilateral muscle power of 4/5 at L2-3, and 0/5 at L4-S1. Thoracic spine magnetic resonance imaging (MRI) showed a fusiform distension of the conus medullaris, with an intradural, intramedullary (ID, IM) mass; isointense on T1, and hyperintense on T2. She had T12-L1 laminectomy with complete resection of the mass. Histopathological evaluation revealed a granulomatous lesion with Schistosoma haematobium ova. Patient subsequently had praziquantel and steroid therapy postoperatively, with complete resolution of back pain, and regain of full muscle power of 5/5 at L2-L4, and 3/5 at L5-S1, in both limbs.

This case demonstrates the need for a high index of suspicion in considering Schistosomiasis as a differential diagnosis of ID, IM tumor of the conus medullaris in pediatric patients. This will result in a prompt diagnosis, and the early institution of appropriate therapy which is often associated with good outcome.