[Cerebral schistosomiasis with a huge calcification. A case report]

Area of Science:

• Neurology
• Parasitology
• Radiology

Background:

• Cerebral schistosomiasis is a rare parasitic infection of the brain caused by Schistosoma species.
• Neuroschistosomiasis can present with diverse neurological symptoms and imaging findings.

Observation:

• A 39-year-old male presented with a long history of neurological deficits, including ataxic gait, headache, and visual disturbances.
• Imaging revealed a large (11x9x9 cm) calcified mass in the right occipital region with hydrocephalus.
• Surgical exploration identified a calcified mass with gelatinous content, confirmed microscopically to contain Schistosoma japonica egg shells.

Findings:

• Microscopic examination of the calcified mass revealed numerous Schistosoma japonica egg shells, necrotic tissue, and inflammatory cells.
• The patient exhibited eosinophilia (10%), a common finding in parasitic infections.
• The large calcification, initially suspected as a granuloma, was definitively diagnosed as cerebral schistosomiasis.

Implications:

• This case highlights the importance of considering parasitic infections in the differential diagnosis of intracranial calcifications, especially in endemic areas.
• The extensive calcification and long clinical course underscore the potential for chronic neurological sequelae from cerebral schistosomiasis.
• Accurate diagnosis and understanding of the pathophysiology are crucial for managing neuroschistosomiasis and preventing long-term disability.