DIAGNOSTIC APPROACHES TO IMPORTED SCHISTOSOMAL MYELORADICULOPATHY IN TRAVELERS

Abstract

Schistosomiasis affects more than 200 million people around the world.1 Schistosomal myeloradiculopathy (SMR) is an inflammation of the spinal cord (myelitis) or nervous roots (radiculitis) due to schistosomiasis, mostly reported with S mansoni or S hematobium .2 We describe three cases of SMR in travelers from France, defined as nonimmune patients, briefly exposed to schistosomiasis, and then discuss diagnosis approach in this population. ### Case reports. #### Patient 1. A 58-year-old man was hospitalized for subacute paraparesis. Four weeks after trekking in Madagascar, a dysenteric syndrome appeared with 5,214 eosinophils/mm3 and identification of S mansoni eggs in stool. Forty mg/kg of praziquantel was administered. Two days later, bilateral pain in the legs, gait instability, and dysuria appeared. Physical examination revealed distal weakness in lower limbs with stepping and right quadriceps fasciculation. Schistosomal serology was positive with hemagglutination (HA) and indirect immunofluorescence (IFI) at 1/320 (normal < 1/160). CSF showed seven cells/mm3 (70% lymphocytic and 30% eosinophils), normoglycorrhachia, and 0.57 g/dL proteins. Three praziquantel daily doses of 40 mg/kg and five daily prednisolone doses of 500 mg were administered, followed by 1 mg/kg oral prednisolone tapered within 1 month. Neurologic symptoms had completely reversed in 24 hours and MRI at 3 months had normalized. #### Patient 2. A 29-year-old man was hospitalized for progressive gait disorder 4 …